[The renin-angiotensin-aldosterone system in the diagnosis of renovascular arterial hypertension].

Twenty one subjects with sistemic arterial hypertension and arteriographic signs of obstructive lesion of the renal artery were studied and classified in 3 groups: group A, 13 cases with bilateral renovascular lesions; group B, 4 patients with unilateral renovascular stenosis and group C, formed by 4 subjects with a segmental branch stenosis of a renal artery. In all cases an special protocol was followed to measure plasma renin activity (PRA) in blood taken from a peripheral vein, inferior vena cava and both renal veins and also to determine 24 hrs. urinary excretion of aldosterone (UEA). PRA and UEA were clasified as high, normal and low by comparing the results with those of normal subjects in a nomogram estimated in the same laboratory in which PRA and UEA values were correlated with 24 hrs. urinari sodium excretion. Besides, R greater than /R less than index (highest PRA of renal vein blood/PRA of contralateral renal vein) and V-A A index (V = PRA of renal vein blood; A = PRA of inferior vena cava) were calculated. Forty eight and thirty eight percentage of the cases had either high renin in peripheral venous blood or high UEA. Similar data in patients with essential hypertension previously studied in the same laboratory were 12 and 10% respectively. V-A A index was incongruent with the arteriographic image in 3 cases of group B; 4 cases of group A and 2 of group B had a pattern of bilateral stenosis, and one case in each group A and C had a unilateral stenosis pattern. In the other patients the samples were "non representative" due to a high level of PRA in the inferior vena cava blood comparable to PRA of the renal veins. Six cases of group A had a R greater than /R less than index superior to 1.5, which suggested a predominant vascular lesion in one side not always congruent with the arteriographic findings. In 3 cases of group B this index was higher than 1.5 in favor of the ipsilateral lesion. Three cases of group C had a normal R greater than /R less than index and one with a total oclussion of a segmental artery presented an index superior to 1.5, ipsilateral to the lesion. The latter index was of value in the diagnosis of renovascular arterial hypertension.