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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of auto-transplantation of the kidney are presented. The first was carried out without prior planning during a ureterolysis procedure for retro-peritoneal fibrosis with a single kidney, by virtue of per-operative thrombosis of the renal artery. The second was used in the treatment of hypertension due to bilateral atheromatous renal artery stenosis with a lesion at the main bifurcation of the artery. In both these cases in which the surgical indication was related to the artery, the ureter was left intact. After 2 and 1 years respectively, the results are good. The important points of operative technique and tactics are emphasised. The order of the technique is important. It resembles that of homo-transplantation but in this case section and reimplantation of the ureter may be avoided. Preservation of the disconnected kidney is ensured by refrigeration with intra-arterial perfusion. Even if only for a short time, it consistently avoids the development of ischaemic tubulopathy. Ex-sito surgery, studied here in detail, is used in dealing with intra-hilar arterial lesions, tumours of both kidneys or a single remaining kidney, complicated cases of lithiasis etc. The results of the 100 known cases of renal auto-transplantation are analysed. They are good in 84 cases. The indications are discussed with regard to the different types of arterial, ureteral, neoplastic, traumatic and miscellaneous lesion.
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PMID:[Renal autotransplantation or iliac transposition of the kidney after section of its vascular pedicle. Apropos of 2 personal cases. Review of 100 published cases]. 79 16

After 268 kidney allotransplants, 7 cases of renal artery stenosis were observed. An additional 3 patients were referred to use from another center. The outstanding symptom of all 10 patients was hypertension refractory to medical treatment, beginning not later then 10 months after transplantation. In 9 cases there was a murmur over the transplant. In 6 patients hypertension was accompanied by a deterioration of renal function which was resistant to antirejection therapy. The tentative diagnosis was confirmed by selective renal arteriography of the transplant. Two main types of stenoses could be diagnosed: Segmental stenoses, 0.5-2 cm distal to the anastomosis, which were due to intimal lesions caused during removal of the kidney or by the perfusion canula; and kinking stenoses due to a technically inadequate implantation. Hypertension was controlled in all but 1 patient with reconstruction of the artery. Therefore, hypertension after kidney transplantation refractory to medical treatment should be further investigated with selective renal arteriography of the transplant. Stenoses with clinical symptoms which are confirmed by arteriography should be surgically corrected.
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PMID:[Arterial stenoses after kidney transplantation]. 79 99

In about 15% of cases hypertension is caused by renal diseases, including unilateral and bilateral parenchymatous nephropathies, renal artery stenosis and renin producing tumors. Important pathogenic determinants are the sodium volume status and the renin angiotensin system. The level of the blood pressure may also depend on the duration of hypertension. An increase in peripheral resistance plays a more important role than an increase in cardiac index. Simultaneous determination of the renin activity in both renal veins is of decisive importance in the diagnosis of renal artery stenosis. Drug treatment of renal hypertension is not essentially different from that of essential hypertension. Surgical procedures include revascularization, uninephrectomy and, in uncontrollable hemodialysis patients, binephrectomy.
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PMID:[Renal hypertension]. 79 75

A child with neurofibromatosis and hypertension also demonstrated renal artery stenosis, the most common cause of hypertension in children with neurofibromatosis; abdominal coarctation, which has previously been described; and thoracic coarctation, which to our knowledge, has not been previously reported. Rib notching may appear in patients with uncomplicated nueorfibromatosis, but the possibility of associated thoracic coarctation must also be considered in these patients.
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PMID:Thoracic coarctation associated with neurofibromatosis. 80 24

A case of hypertension in a patient with neurofibromatosis and renal artery stenosis with aneurysm formation in a solitary kidney is described. Studies of plasma renin activity and body sodium content are presented and have been related to findings in patients and experimental animals with renovascular hypertension. A reconstructive operative procedure is described in which the kidney is perfused in situ.
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PMID:Hypertension and renal artery stenosis with aneurysm formation in a solitary kidney in a patient with neurofibromatosis. 80 81

Fifty patients who underwent renal angiography and bilateral renal venous determinations had reconstructive or ablative surgery. The importance of stimulating renin release was underlined in 11 patients who attained a renal venous ratio greater than 1.5 to 1 only after being in an upright posture and in 5 who were studied with and without salt depletion. A protocol designed to suppress or stimulate peripheral plasma renin activity was followed in 19 patients. Stimulated peripheral plasma renin activity was not useful in identifying hypertension of renovascular origin but 10 of 12 patients whose plasma renin activity was not suppressed normally were improved by an operation. Satisfactory surgical responses were obtained in 81 per cent of the patients with unilateral and 91 per cent with bilateral atherosclerosis, and 88 per cent with unilateral and 60 per cent with bilateral fibromuscular hyperplasia. Our observations indicate that renal artery stenosis can be identified consistently only by angiography. A stimulated renal venous renin rate of 1.5 to 1 appears to have the best predictive value in surgical control of renovascular hypertension.
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PMID:Improved diagnostic accuracy of renal venous renin ratios with stimulation of renin release. 83 54

Hypertension secondary to segmental renal ischemia caused by segmental renal artery stenosis has been relieved by nephrectomy, partial nephrectomy, excision of atrophic segments, or repair of the segmental vessels. This is a report of hypertension caused by stenosis of a segmental renal artery and cured by simple ligation of the stenotic artery.
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PMID:Correction of renal hypertension by ligation of stenotic segmental renal artery. 84 6

Acute renal artery stenosis in hydropenic dogs caused a contralateral increase in urine volume and free water clearance without change in glomerular filtration, renal blood flow, or osmolar clearance. The increase in urine volume was not dependent on the development of hypertension since it occurred in animals pretreated with trimethaphan but was dependent upon angiotensin since it was presented with angiotensin blockade with Saralasin. The effect was not caused by angiotensin inhibiting antidiuretic hormone release since the polyuria occurred in hypophysectomized animals receiving a constant infusion of 10 muU/kg per min of aqueous Pitressin. Since the rise in urine volume was associated with an increase in renal vein prostaglandin E concentration and was prevented by pretreatment with indomethacin (5 mg/kg) the results suggest that the rise in plasma angiotensin after renal artery stenosis causes an increase in contralateral prostaglandin E synthesis with resultant antagonism to antidiuretic hormone at the collecting tubule.
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PMID:Studies of the mechanism of contralateral polyuria after renal artery stenosis. 84 53

In patients with renovascular hypertension, a significant decrease in glomerular filtration rate (GFR) and in renal plasma flow (RPF) in the stenotic kidney was accompanied by a significant homolateral decrease in extraction of PAH(EPAH) and in net tubular reabsorption of sodium (RNa). There was a highly significant correlation between differences in RNa and differences in either GFR or RPF, while no correlation between differences in RNa and in EPAH was noted. It is suggested that the nature of the relationship between GFR and RNa is essentially the same in unilateral renal artery stenosis in man, as in acute constriction of the renal artery or the aorta in the experimental animal.
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PMID:Relationship between glomerular filtration rate and tubular reabsorption of sodium in patients with unilateral renal artery stenosis. The role of the renal prostaglandins. 84 24

The practical value of renin secretion studies in hypertension associated with unilateral kidney disease, other than renal artery stenosis, has not been documented. This study, comprising 19 patients of this kind, disclosed three who had an abnormal renin secretion from the diseased kidney. The level of peripheral renin under basal conditions, and the change from this level as a result of provocation of renin secretion, were used to evaluate the importance of an arteriovenous renin gradient in the diseased kidney. The three patients were the only ones to become normotensive when the diseased kidney was removed in seven of the cases studied. When nephrectomy is considered in severe hypertension with unilateral kidney disease, there is a place for renin secretion studies, but a screening procedure is advisable. Measuring peripheral renin under basal conditions and after provocation of renin secretion, should reveal whether the renin-angiotensin system might be playing a part in maintaining the high BP. The finding of diminishing kidney function in many of the patients, despite good BP control, emphasizes the importance of sparing kidney function whenever possible.
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PMID:Renin-dependent hypertension in patients with unilateral kidney disease not caused by renal artery stenosis. 85 Oct 43


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