RENAL ARTERIAL STENOSIS AND HYPERTENSION—MEDICAL OR SURGICAL MANAGEMENT?
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Excerpt
Sympathectomy was among the earliest forms of surgical intervention in the management of hypertension. Awareness of the importance of renal ischemia as a cause of hypertension led to the increased utilization of nephrectomy for relief of hypertension secondary to unilateral kidney disease. The most frequent etiological causes of unilateral renal disease are pyelonephritis and diseases of main renal arteries and their primary branches. More recently, emphasis has shifted to a surgical approach in patients with occlusive renal arterial disease. Yet to be answered, however, are questions which invariably arise after initial enthusiastic reception of new concepts in management of disease. Which patients with hypertension and renal arterial stenosis are the best candidates for operation, and in whom is surgical treatment unjustified? Are kidney function tests helpful in predicting therapeutic success? How effective are antihypertensive drugs in controlling hypertension secondary to renal arterial stenosis? Dustan and associates1 have recently reported
