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Rare forms of renal hypertension

Seltene Formen renaler Hypertonie

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Summary

In the present study 19 patients with rare forms of renal hypertension were investigated: 6 patients with renal artery aneurysm, 6 cases with unilateral hydronephrosis, 4 patients with unilateral simple renal cyst, 2 cases with coarctation of the abdominal aorta and associated renal artery stenosis and 1 patient with radiation nephritis.

Renal venous renin activity (PRA) was determined in 17 of the 19 cases. Seven of these 17 (41%) patients showed significant PRA-ratios (PRA affected/PRA unaffected side ≧1.5). The percentage of positive tests was comparably high in the various subgroups except in patients with renal cyst, none of them showing lateralisation of renin secretion. Selective sampling in 2 patients with renal artery branch aneurysm revealed in both cases marked local renin oversecretion.

Fifteen of the 19 patients (79%) were operated either by reconstruction surgery or nephrectomy. Four cases with a renal artery aneurysm were treated with antihypertensive drugs.

Patients with unilateral hydronephrosis showed the best response to surgery in terms of cure rate (3 cured, 3 improved), whereas blood pressure normalisation could not be achieved in patients with simple renal cyst (2 improved, 1 unimproved). Patients with coarctation of the abdominal aorta and associated renal artery stenosis and the 2 operated cases with renal artery aneurysm showed a good effect of corrective surgery (2 cured, 2 improved). The patient with radiation nephritis finally was improved 2 years after nephrectomy.

For the total group the prognostic validity of renal venous renin determination was limited. However, selective blood sampling from peripheral renal veins may be useful in cases with renal artery branch aneurysm to detect local oversecretion of renin.

Zusammenfassung

In der vorliegenden Studie wurden 19 Patienten mit seltenen Formen renaler Hypertonie untersucht: 6 Patienten mit Nierenarterienaneurysma, 6 Fälle mit unilateraler Hydronephrose, 4 Patienten mit unilateraler Nierencyste, 2 Fälle mit Coarctatio aortae und assozierter Nierenarterienstenose und ein Patient mit Strahlennephritis.

Die Plasma-Renin-Aktivität (PRA) im Nierenvenenblut wurde bei 17 der 19 Fälle bestimmt. 7 dieser 17 (41%) Patienten zeigten einen signifikanten Seitenunterschied (PRA betroffene/PRA nicht betroffene Seite) ≧1,5. Der Prozentsatz positiver Tests war in verschiedenen Kollektiven vergleichbar hoch. Nur Patienten mit unilateraler Nierencyste zeigten in keinem Fall einen signifikanten PRA-Quotienten. Eine superselektive Nierenvenenrenin-Bestimmung bei 2 Patienten mit Nierenarterienaneurysma der oberen Segmentarterie zeigte in beiden Fällen eine erhöhte Plasma-Renin-Aktivität im Bereiche des Oberpols.

15 der 19 Patienten (79%) wurden operiert. Dabei kamen entweder plastisch rekonstruktive Verfahren oder eine Nephrektomie zur Anwendung. 4 Fälle mit Nierenarterienaneurysma wurden antihypertensiv behandelt.

Patienten mit unilateraler Hydronephrose zeigten postoperativ die besten Ergebnisse (3 geheilt, 3 gebessert), während bei keinem der 4 Patienten mit unilateraler Nierencyste die Blutdruckwerte durch den operativen Eingriff normalisiert werden konnten (3 gebessert, 1 nicht gebessert). Die Patienten mit Coarctatio aortae und assozierter Nierenarterienstenose sowie die 2 operierten Fälle mit Nierenarterienaneurysma zeigten alle ein gutes Ansprechen auf den gefäßrekonstruktiven Eingriff (2 geheilt, 2 gebessert). Der Patient mit Strahlennephritis schließlich war 2 Jahre nach Nephrektomie gebessert.

Im Gesamtkollektiv unserer operierten Patienten war die prognostische Aussagekraft der Nierenvenenreninbestimmung beschränkt. Allerdings erwies sich die selektive Nierenvenenreninbestimmung bei Patienten mit einem Aneurysma einer Nierensegmentarterie als nützlich zur Entdeckung lokaler Reninüberproduktion.

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Authors and Affiliations

  1. Radiologische Universitätsklinik Bonn, Germany

    I. Schmitt

  2. Dept. f. Innere Medizin, Universitätsspital, CH-8091, Zürich, Switzerland

    T. Lüscher, H. Vetter, G. Pouliadis, U. Kuhlmann, A. Studer, D. Hauri, B. Wicky, I. Schmitt, N. Satz, W. Siegenthaler &  W. Vetter

  3. Medizinische Poliklinik, University of Münster i. Westf., Germany

    T. Lüscher, H. Vetter, G. Pouliadis, U. Kuhlmann, A. Studer, D. Hauri, B. Wicky, I. Schmitt, N. Satz, W. Siegenthaler &  W. Vetter

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Lüscher, T., Vetter, H., Pouliadis, G. et al. Rare forms of renal hypertension. Klin Wochenschr 59, 35–45 (1981). https://doi.org/10.1007/BF01477328

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