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Evidence for Abnormal Vasoconstriction-Volume Interaction

E. Darracott Vaughan, Jr., MD; Fritz R. Bühler, MD; John H. Laragh, MD; Jean E. Sealey; Harry Gavras, MD; Les Baer, MD

JAMA. 1975;233(11):1177-1183.

Abstract
Hypertension was not renin-dependent in the majority of 62 hypertensive patients with seemingly unilateral renal parenchymal disease, as indicated by plasma renin activity: low in 14 (23%), normal in 40 (56%), and high in only 8 (13%). By a weighted scoring system for analysis of differential renal-vein and peripheral renin levels, 70% (16 of 23) of these patients did not give scores predictive of cure by nephrectomy. Thus, occult bilateral disease reflected by attendant volume expansion and consequent reactive renin suppression may explain the well-known disappointing cure rate after uninephrectomy in this group.

Since unilateral hypersecretion of renin with a completely normal contralateral kidney is rare in this group, abnormal renal-vein and peripheral renin values should be a prerequisite for advising nephrectomy, especially when the suspected kidney shows considerable excretory function.

(JAMA 233:1177-1183, 1975)

Author Affiliations
From the Department of Medicine, College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York. Dr. Vaughan is now with the Department of Urology, University of Virginia Medical Center, Charlottesville. Dr. Bühler is now with the Department of Medicine, University of Basel, Basel, Switzerland. Drs. Laragh and Gavras and Ms. Sealey are now with the Department of Medicine, New York-Cornell Medical Center, New York.

Footnotes
Reprint requests to Department of Urology, University of Virginia Medical Center, Charlottesville, VA 22901 (Dr. Vaughan).

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