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Renovascular disease due to progressive atherosclerotic renal artery stenosis is being diagnosed with increasing frequency in the elderly. At what degree of renal artery stenosis should intervention be recommended is not clear. To answer this question, unilateral and bilateral activation of the reninangiotensin system (RAS) or its absence were detected by captopril-stimulated renal vein renin measurements in 49 hypertensive patients, aged 63, and the information was matched against radiographic measurements of the extent of renal artery stenosis. All patients had normal or near-normal renal function (serum creatinine ,2.0 mg/ml), single artery per kidney, and no previous renal artery intervention. There were 9 patients with normal secretion, 27 with unilateral hypersecretion and contralateral suppression, and 13 with bilateral hypersecretion of renin. Of the 53 hypersecreting kidneys all but 4 had renal artery (luminal area) stenosis of 80% or greater. All 45 kidneys with normal secretion or complete suppression of renin release contralateral to a hypersecreting kidney had either normal caliber renal artery or renal artery stenosis less than 80%, with two exceptions of 80% stenosis each. These findings suggest that renal artery stenosis of at least 80% is required for activation of the RAS. Consequently, patients with renal artery stenosis less than 80% should be monitored rather than treated because improvement of renal function and amelioration of hypertension are not expected unless the RAS has been activated in the affected kidneys.

american journal of hypertension

Left ventricular hypertrophy (LVH) in hypertensive patients with autosomal dominant polycystic kidney disease (ADPKD): influence of blood pressure (BP) and humoral and neurohormonal factors