Renal secretion of inactive renin and extraction of angiotensin II in renal artery stenosis in man: factors determining renal vein renin ratio.

Triplicate blood samples were obtained, without stimulation, simultaneously from the aorta and both renal veins in 24 untreated hypertensive patients with unilateral renal artery stenosis. Across the affected kidney the plasma concentrations of active renin, inactive renin and angiotensin II increased by 363% (P less than 0.001), 80% (P less than 0.05) and 100% (P less than 0.05) respectively. Thus the affected kidney was secreting both active and inactive renin, while appreciable quantities of angiotensin II were generated across the renal circulation on that side. Across the contralateral unaffected kidney there were no significant changes in concentration of active or inactive renin, indicating net suppression of secretion of both forms of renin. Plasma angiotensin II concentration was however markedly reduced, to 50% of the arterial value (P less than 0.001), in the contralateral renal vein, demonstrating renal extraction of angiotensin II. In 14 patients renal plasma flow was also measured. The ratio of active renin concentration between the two renal veins correlated more closely with the renal plasma flow to the affected kidney (r = -0.81; P less than 0.01) than with renin secretion rate on that side (r = +0.37; NS). Thus reduction in renal blood flow rather than increase in renin secretion appeared to be the major determinant of renal vein renin ratio.