Ekeström S, Liljeqvist L, Nordhus O, Tidgren B
Scand J Urol Nephrol. 1979;13(1):83-8. doi: 10.3109/00365597909180004.
Twenty-four patients with persisting hypertension after renal artery reconstruction were re-investigated 1--8 years after surgery. They underwent renal arteriography, determination of plasma renin activity, renography and renal function studies in order to find the causes of the postoperative hypertension. Restenosis was found in 6 patients, in 3 of whom it was of functional significance according to the positive renin tests (renin ratio greater than 1.5). Positive renin tests were found in 2 other patients. One had occlusion of a renal artery branch and the other hypoplasia of the kidney due to chronic nephritis. No explanation of the persisting hypertension could be found in 19 patients at re-examination. In 10 of them, however, biopsy from the affected kidney obtained during operation showed nephrosclerosis, which may explain the outcome. Fourteen of the 19 patients had negative renin tests preoperatively. These negative tests indicate that renal artery stenosis was not the only cause of hypertension. It may be concluded that the renin test is of the utmost value in the selection of patients for renal artery reconstruction and should always be considered. A biopsy from the contralateral kidney may be necessary in order to detect other causes of hypertension than renal artery stenosis. The importance of re-investigating patients with persisting hypertension is confirmed by the present study.
对24例肾动脉重建术后仍有持续性高血压的患者在术后1至8年进行了再次研究。他们接受了肾动脉造影、血浆肾素活性测定、肾图检查和肾功能研究，以寻找术后高血压的原因。6例患者发现有再狭窄，其中3例根据肾素试验阳性（肾素比值大于1.5）具有功能意义。另外2例患者肾素试验阳性。1例肾动脉分支闭塞，另1例因慢性肾炎导致肾发育不全。再次检查时，19例患者未发现持续性高血压的原因。然而，其中10例在手术中取自患肾的活检显示有肾硬化，这可能解释了结果。19例患者中有14例术前肾素试验阴性。这些阴性试验表明肾动脉狭窄不是高血压的唯一原因。可以得出结论，肾素试验在选择肾动脉重建患者方面具有极其重要的价值，应始终予以考虑。为了检测除肾动脉狭窄以外的其他高血压原因，可能需要对侧肾活检。本研究证实了对持续性高血压患者进行再次研究的重要性。
