Studies on renovascular hypertension

Mackay, Alistair (1980) Studies on renovascular hypertension. MD thesis, University of Glasgow.

Abstract

Aspects of the pathogenesis, diagnosis, prognosis and management of renal artery stenosis have been studied in 86 hypertensive patients and in experimental animals. PATHOGENESIS: Mean exchangeable sodium was normal in patients with unilateral renal artery stenosis compared with normo-tensive controls, but the relation between exchangeable sodium and blood pressure was significant and negative (r = -0.62, p <0.001) in contrast to other forms of hypertension. Patients with the lowest exchangeable sodium had hyponatraemia, hypokalaemia, and secondary hyperaldosteronism - the "hyponatraemic hypertensive syndrome". Urinary sodium excretion from the unaffected kidney correlated positively (r = +0.51, p <0.01) with arterial pressure, possibly reflecting the phenomenon of pressure natriuresis. Patients who responded least well to subsequent surgery excreted least sodium from the unaffected kidney for a given arterial pressure, and maintained this relationship after surgery. The findings suggest an important role for arterial pressure in the control of sodium balance in contrast to Conn's syndrome where the roles are reversed. Before surgery arterial pressure was disproportionately high for a given plasma angiotensin II concentration in patients with unilateral renal artery stenosis in comparison with normal individuals infused with angiotensin II. After successful surgery this relation fell towards normal, consistent with a slow pressor action of angiotensin II in renovascular hypertension. Cigarette smoking was found to be significantly commoner (p <0.001) in patients with non-malignant hypertension and renal artery stenosis (84% smoked) than in age- and sex-matched controls with non-malignant hypertension without renal artery stenosis who were inpatients (46% smoked) or were attending the Glasgow Blood Pressure Clinic (44% smoked). The differences were significant for men and women separately, and for subgroups with renal artery occlusion, fibromuscular hyperplasia, and stenosis due to atheroma. 91% of patients with renal artery stenosis and malignant-phase hypertension at the time of presentation also smoked. Fibromuscular hyperplasia is one cause of renal artery stenosis whose aetiology remains obscure. Of 23 patients with this condition 21 were women, but no relationship between fibromuscular hyperplasia and pregnancy could be established. The right renal artery was involved twice as often as the left, perhaps reflecting a greater, degree of nephroptosis on that side.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: R Medicine > RC Internal medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Supervisor, not known
• Date of Award: 1980
• Depositing User: Enlighten Team
• Unique ID: glathesis:1980-83193
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 13 Oct 2022 14:12
• Last Modified: 13 Oct 2022 14:12
• Thesis DOI: 10.5525/gla.thesis.83193
• URI: https://theses.gla.ac.uk/id/eprint/83193

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