Clinical and Physiological Factors Determining Diagnosis and Choice of Treatment of Renovascular Hypertension

A review of the medical literature and a study of 180 subjects with hypertension have revealed no clear-cut clinical syndrome to distinguish renovascular hypertension from essential hypertension. The single most useful clinical sign is an upper abdominal bruit, which was found in 50% of patients with renovascular hypertension. Renovascular hypertension does not simulate primary aldosteronism. Hypokalemia is related to the severity of hypertension, regardless of etiology. Experimental and clinical renal artery stenosis results in decreased renal blood flow and glomerular filtration rate and increased fractional reabsorption of sodium and water. These physiological changes are correlated with specific aspects of various clinical tests. All clinical tests (radioisotope renogram, modified intravenous urogram, individual kidney function studies) are of diagnostic value in the presence of unilateral main renal artery lesions. They are less reliable in the presence of bilateral and segmental lesions. The most sensitive diagnostic test would appear to be the modified intravenous urogram when multiple criteria are utilized. Insufficient and conflicting data prevent accurate assessment of the diagnostic value of pressure activity measurements and renal biopsies. The predictive value of all proposed tests is questionable.

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