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Peripheral and Renal Vein Renin Activity in Patients with Renovascular Hypertension Due to Nonspecific Aortoarteritis

Department of Pharmacology, All India Institute of Medical Sciences

V. Dave

Department of Pharmacology, All India Institute of Medical Sciences

S.C. Dash

Department of Nephrology, All India Institute of Medical Sciences

S. Bhargava

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

The diagnostic utility of peripheral and renal vein renin estimations in rela tion to angiographic findings was evaluated in 13 patients with renovascular hyper tension and non-specific aortoarteritis (NSAA, Gr I), in comparison with 10 patients with renal artery stenosis due to other causes (Gr II). Plasma renin ac tivity (PRA) was measured by radioimmunoassay. Blood samples were collect ed after angiography from the femoral vein and renal vein on the affected side followed by sampling from the less affected or unaffected side. Renal vein renin ratio (RVRR) was calculated from renal vein renin values. The effect of cap topril (25 mg oral) on blood pressure, PRA, and RVRR was examined in 8 pa tients from each group. Normotensive volunteers (8) with moderately low salt intake were also included in the study for comparison of twenty-four-hour uri nary sodium output, peripheral PRA, and response to captopril.

The mean peripheral PRA was high in both groups as compared with normo tensive controls; however, the values were lower in patients with NSAA. The rise in PRA in response to captopril was insignificant in Gr I (p >0.05) and RVRR > 1.5 was observed in 5 of 13 patients in contrast to 9 of 10 in Gr II (p < 0.05). A paradoxical ratio, ie, (high renal vein renin levels on the less stenotic side) was noticed in 3 patients of Gr I, whereas none of the patients of GR II showed such a ratio. An improvement in RVRR after captopril was observed in 50% of patients of Gr I as compared with a marked response in all patients of Gr II.

The predictive value of RVRR for positive outcome of surgery or angioplasty could be assessed in only 5 patients owing to extensive bilateral involvement and poor general condition of patients with NSAA. Two patients with RVRR > 1.5 and 1 with a false-negative ratio were cured after unilateral nephrectomy/ angioplasty, whereas 2 with RVRR < 1.5 did not show any improvement; prob ably bilateral intervention in these was required. On the other hand, all the 8 patients of Gr II were benefited after unilateral intervention. It is concluded that peripheral PRA and RVRR are useful indices in patients with NSAA for diag nosis and planning surgery/angioplasty and also in avoiding unnecessary surgi cal intervention in patients with paradoxical ratio.

Angiology, Vol. 42, No. 12, 979-984 (1991)
DOI: 10.1177/000331979104201207


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