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Renin in the Diagnosis of Renovascular Hypertension: Title and subTitle BreakActivity in Renal and Peripheral Vein Plasma FREE

Bertram M. Winer, MD; Wilhelm F. Lubbe, MB, ChB; Morris Simon, MD; John A. Williams, MD
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Reprint requests to 330 Brookline Ave, Boston 02114 (Dr. Winer).


JAMA. 1967;202(2):121-128. doi:10.1001/jama.1967.03130150089017
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Renin activity was assayed in plasma from the right and left renal veins and a peripheral vein in 47 hypertensive patients. Activity was equivalent in the two renal veins in 25 patients without renal artery stenosis; peripheral vein activity averaged 20% less. Ten of 17 patients with angiographic evidence of unilateral renal artery stenosis had significantly greater renin activity in the vein of the involved kidney; peripheral vein renin activity was equal to that from the vein of the uninvolved kidney. Two of five patients with bilateral stenosis had significant differences in renin activity between the two sides. The correlation between the results of the assays and results of surgery (14 cases) was excellent. Differential renal vein renin assays have diagnostic value in the determination of the functional significance of apparent unilateral renovascular disease.

REFERENCES

Eyler, W.R., et al:  Angiography of the Renal Areas Including a Comparative Study of Renal Arterial Stenoses in Patients With and Without Hypertension , Radiology 87:879-891 ( (June) ) 1962;.
Holley, K.E., et al:  Renal Artery Stenosis: A Clinical-Pathologic Study in Normotensive and Hypertensive Patients , Amer J Med 37:14-22 ( (July) ) 1964;.
Schwartz, C.J., and White, T.A.:  Stenosis of Renal Artery: An Unselected Necropsy Study , Brit Med J 2:1415-1421 ( (Dec 5) ) 1964;.
Maxwell, M.H., et al:  Use of Rapid-Sequence Intravenous Pyelogram in the Diagnosis of Renovascular Hypertension , New Eng J Med 270:213-220 ( (Jan 30) ) 1964;.
Block, J.B., and Burrows, B.A.:  Diagnostic Use of I131 Diodrast in Hypertension Due to Unilateral Renal Disease , Circulation 18:696 ( (Oct) ) 1958;.
Kaplan, N.M., and Silah, J.G.:  Angiotensin-Infusion Test: New Approach to Differential Diagnosis of Renovascular Hypertension , New Eng J Med 271:536-541 ( (Sept 10) ) 1964;.
Howard, J.E., and Connor, T.B.:  Use of Differential Function Studies in the Diagnosis of Renovascular Hypertension , Amer J Surg 107:58-66 ( (Jan) ) 1964;.
Stamey, T.A.: Renovascular Hypertension , Baltimore: Williams & Wilkins Co., 1963;.
McPhaul, J.J., Jr., et al:  Pressor Activity of Renal Venous Blood in Hypertension , Ann Intern Med 61:847-852 ( (Nov) ) 1964;.
Vertes, V.; Grauel, J.A.; and Goldblatt, H.:  Renal Arteriography, Separate Renal-Function Studies and Renal Biopsy in Human Hypertension , New Eng J Med 270:656-659 ( (March 26) ) 1964;.
Winer, B.M.; Simon, M.; and Williams, J.:  Renal Vein Renin and Renovascular Hypertension , Amer J Cardiol 15:151 ( (Jan) ) 1965;.
Seldinger, S.I.:  Catheter Replacement of Needle in Percutaneous Arteriography: New Technique , Acta Radiol 39:368-376 ( (May) ) 1953;.
Helmer, O.M., and Judson, W.E.: " The Presence of Vasoconstrictor and Vasopressor Activity in Renal Vein Plasma of Patients With Arterial Hypertension ," in Skelton, F.R. (ed.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1960;, vol 8, p 38.
Boucher, R., et al:  New Procedures for Measurement of Human Plasma Angiotensin and Renin Activity Levels , Canad Med Assoc J 90:194-201 ( (Jan 25) ) 1964;.
Tobian, L.:  Interrelationship of Electrolytes, Juxtaglomerular Cells and Hypertension , Physiol Rev 40:280-312 ( (April) ) 1960;.
Skinner, S.L.; McCubbin, J.W.; and Page, I.H.:  Control of Renin Secretion , Circ Res 15:64-76 ( (July) ) 1964;.
Vander, A.J.: " Nature of the Stimulus for Renin Secretion in Anesthetized Dogs ," in Rodbard, S., Sapirstein, L.A., and Wood, J.E. (eds.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1965;, vol 13, p 126.
Laragh, J.H., et al:  Hypotensive Agents and Pressor Substances: The Effect of Epinephrine, Norepinephrine, Angiotensin II and Others on the Secretory Rate of Aldosterone in Man , JAMA 174:234-240 ( (Sept 17) ) 1960;.
Genest, J.:  Angiotensin. Aldosterone and Human Arterial Hypertension , Canad Med Assoc J 84:403-419 ( (Jan 25) ) 1961;.
Khairallah. P.A., et al:  Angiotensinase With a High Degree of Specificity in Plasma and Red Cells , Science 140:672-674 ( (May 10) ) 1963;.
Pickens, P.T., et al:  Measurement of Renin Activity in Human Plasma , Circ Res 17:438-447 ( (Nov) ) 1965;.
Brown, J.J., et al:  Variations in Plasma Renin Concentration in Several Physiological and Pathological States , Canad Med Assoc J 99:201-206 ( (Jan 25) ) 1964;.
Winer, B.M.:  Humoral Vasoconstrictor Effect of Diuretics , Circulation , abstracted, 28:805 ( (Oct) ) 1962;.
Winer, B.M.: " A Humoral Vasoconstrictor Effect of Salt Depletion ," in Proceedings of the New England Cardiovascular Society, 1962-1963 , Boston: Massachusetts Heart Association, 1963;, vol 21, pp 43-44.
Brown, J.J., et al:  Influence of Sodium Loading and Sodium Depletion on Plasma Renin in Man , Lancet 2:278-279 ( (Aug 10) ) 1963;.
Veyrat, R., et al:  Measurement of Human Arterial Renin Activity in Some Physiological and Pathological States , Canad Med Assoc J 90:215-220 ( (Jan 25) ) 1964;.
Huidobro, F., and Braun-Menendez, E.:  Secretion of Renin by the Intact Kidney , Amer J Physiol 137:47-55 ( (Jan) ) 1942;.
Conn, J.W.; Cohen, E.L.; and Rovner, D.R.:  Suppression of Plasma Renin Activity in Primary Aldosteronism , JAMA 190: 213-221 ( (Oct 19) ) 1964;.
Brown, J.J., et al:  Plasma Renin in Normal Pregnancy , Lancet 2:900-902 ( (Nov 2) ) 1963;.
Winer, B.M.:  The Renin System , in Proceedings of the New England Cardiovascular Society, 1963-1964 , Boston: Massachusetts Heart Association, 1964;, vol 22, pp 15 and 16.
Winer, B.M.:  Renin in Pregnancy and the Menstrual Cycle , J Clin Invest , abstracted, 44:1112 ( (June) ) 1965;.
Brown, J.J., et al:  Variations in Plasma Renin During the Menstrual Cycle , Brit Med J 2:1114-1115 ( (Oct 31) ) 1964;.
Haynes, F.W., and Dexter, L.:  Renin, Hypertensinogen, and Hypertensinase Cocentration of Blood of Dogs During the Development of Hypertension by Constriction of the Renal Artery , Amer J Physiol 150:190-197 ( (July) ) 1947;.
Smeby, R.R.; Sen, S.; and Bumpus, F.M.:  A Naturally Occurring Renin Inhibitor , Circ Res 21:129-133 ( (July) ) 1967;.
Maxwell, M.H.; Lupu, A.; and Franklin, S.S.:  Clinical and Physiological Factors Determining Diagnosis and Choice of Treatment of Renovascular Hypertension , presented at the Symposium on Renal Hypertension, Cleveland, October, 1966 .
Nicotero, J.A., et al:  Diagnostic and Physiologic Implications of the Angiotensin Infusion Test , New Eng J Med 274:1464-1468 ( (June 30) ) 1966;.
Connor, T.B., et al:  Hypertension due to Unilateral Renal Disease: With Report on Functional Test Helpful in Diagnosis , Bull Hopkins Hosp 100:241-276 ( (June) ) 1957;.
Judson, W.E., and Helmer, O.M.: " Diagnostic and Prognostic Values " in Rodbard, S., Sapirstein, L.A., and Wood, J.E. (eds.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1965;, vol 13, p 79.
Kirkendall, W.M.: Fitz, A.E.; and Lawrence, M.S.:  Renal Hypertension , New Eng J Med 276:479-485 ( (March 3) ) 1967;.

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Eyler, W.R., et al:  Angiography of the Renal Areas Including a Comparative Study of Renal Arterial Stenoses in Patients With and Without Hypertension , Radiology 87:879-891 ( (June) ) 1962;.
Holley, K.E., et al:  Renal Artery Stenosis: A Clinical-Pathologic Study in Normotensive and Hypertensive Patients , Amer J Med 37:14-22 ( (July) ) 1964;.
Schwartz, C.J., and White, T.A.:  Stenosis of Renal Artery: An Unselected Necropsy Study , Brit Med J 2:1415-1421 ( (Dec 5) ) 1964;.
Maxwell, M.H., et al:  Use of Rapid-Sequence Intravenous Pyelogram in the Diagnosis of Renovascular Hypertension , New Eng J Med 270:213-220 ( (Jan 30) ) 1964;.
Block, J.B., and Burrows, B.A.:  Diagnostic Use of I131 Diodrast in Hypertension Due to Unilateral Renal Disease , Circulation 18:696 ( (Oct) ) 1958;.
Kaplan, N.M., and Silah, J.G.:  Angiotensin-Infusion Test: New Approach to Differential Diagnosis of Renovascular Hypertension , New Eng J Med 271:536-541 ( (Sept 10) ) 1964;.
Howard, J.E., and Connor, T.B.:  Use of Differential Function Studies in the Diagnosis of Renovascular Hypertension , Amer J Surg 107:58-66 ( (Jan) ) 1964;.
Stamey, T.A.: Renovascular Hypertension , Baltimore: Williams & Wilkins Co., 1963;.
McPhaul, J.J., Jr., et al:  Pressor Activity of Renal Venous Blood in Hypertension , Ann Intern Med 61:847-852 ( (Nov) ) 1964;.
Vertes, V.; Grauel, J.A.; and Goldblatt, H.:  Renal Arteriography, Separate Renal-Function Studies and Renal Biopsy in Human Hypertension , New Eng J Med 270:656-659 ( (March 26) ) 1964;.
Winer, B.M.; Simon, M.; and Williams, J.:  Renal Vein Renin and Renovascular Hypertension , Amer J Cardiol 15:151 ( (Jan) ) 1965;.
Seldinger, S.I.:  Catheter Replacement of Needle in Percutaneous Arteriography: New Technique , Acta Radiol 39:368-376 ( (May) ) 1953;.
Helmer, O.M., and Judson, W.E.: " The Presence of Vasoconstrictor and Vasopressor Activity in Renal Vein Plasma of Patients With Arterial Hypertension ," in Skelton, F.R. (ed.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1960;, vol 8, p 38.
Boucher, R., et al:  New Procedures for Measurement of Human Plasma Angiotensin and Renin Activity Levels , Canad Med Assoc J 90:194-201 ( (Jan 25) ) 1964;.
Tobian, L.:  Interrelationship of Electrolytes, Juxtaglomerular Cells and Hypertension , Physiol Rev 40:280-312 ( (April) ) 1960;.
Skinner, S.L.; McCubbin, J.W.; and Page, I.H.:  Control of Renin Secretion , Circ Res 15:64-76 ( (July) ) 1964;.
Vander, A.J.: " Nature of the Stimulus for Renin Secretion in Anesthetized Dogs ," in Rodbard, S., Sapirstein, L.A., and Wood, J.E. (eds.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1965;, vol 13, p 126.
Laragh, J.H., et al:  Hypotensive Agents and Pressor Substances: The Effect of Epinephrine, Norepinephrine, Angiotensin II and Others on the Secretory Rate of Aldosterone in Man , JAMA 174:234-240 ( (Sept 17) ) 1960;.
Genest, J.:  Angiotensin. Aldosterone and Human Arterial Hypertension , Canad Med Assoc J 84:403-419 ( (Jan 25) ) 1961;.
Khairallah. P.A., et al:  Angiotensinase With a High Degree of Specificity in Plasma and Red Cells , Science 140:672-674 ( (May 10) ) 1963;.
Pickens, P.T., et al:  Measurement of Renin Activity in Human Plasma , Circ Res 17:438-447 ( (Nov) ) 1965;.
Brown, J.J., et al:  Variations in Plasma Renin Concentration in Several Physiological and Pathological States , Canad Med Assoc J 99:201-206 ( (Jan 25) ) 1964;.
Winer, B.M.:  Humoral Vasoconstrictor Effect of Diuretics , Circulation , abstracted, 28:805 ( (Oct) ) 1962;.
Winer, B.M.: " A Humoral Vasoconstrictor Effect of Salt Depletion ," in Proceedings of the New England Cardiovascular Society, 1962-1963 , Boston: Massachusetts Heart Association, 1963;, vol 21, pp 43-44.
Brown, J.J., et al:  Influence of Sodium Loading and Sodium Depletion on Plasma Renin in Man , Lancet 2:278-279 ( (Aug 10) ) 1963;.
Veyrat, R., et al:  Measurement of Human Arterial Renin Activity in Some Physiological and Pathological States , Canad Med Assoc J 90:215-220 ( (Jan 25) ) 1964;.
Huidobro, F., and Braun-Menendez, E.:  Secretion of Renin by the Intact Kidney , Amer J Physiol 137:47-55 ( (Jan) ) 1942;.
Conn, J.W.; Cohen, E.L.; and Rovner, D.R.:  Suppression of Plasma Renin Activity in Primary Aldosteronism , JAMA 190: 213-221 ( (Oct 19) ) 1964;.
Brown, J.J., et al:  Plasma Renin in Normal Pregnancy , Lancet 2:900-902 ( (Nov 2) ) 1963;.
Winer, B.M.:  The Renin System , in Proceedings of the New England Cardiovascular Society, 1963-1964 , Boston: Massachusetts Heart Association, 1964;, vol 22, pp 15 and 16.
Winer, B.M.:  Renin in Pregnancy and the Menstrual Cycle , J Clin Invest , abstracted, 44:1112 ( (June) ) 1965;.
Brown, J.J., et al:  Variations in Plasma Renin During the Menstrual Cycle , Brit Med J 2:1114-1115 ( (Oct 31) ) 1964;.
Haynes, F.W., and Dexter, L.:  Renin, Hypertensinogen, and Hypertensinase Cocentration of Blood of Dogs During the Development of Hypertension by Constriction of the Renal Artery , Amer J Physiol 150:190-197 ( (July) ) 1947;.
Smeby, R.R.; Sen, S.; and Bumpus, F.M.:  A Naturally Occurring Renin Inhibitor , Circ Res 21:129-133 ( (July) ) 1967;.
Maxwell, M.H.; Lupu, A.; and Franklin, S.S.:  Clinical and Physiological Factors Determining Diagnosis and Choice of Treatment of Renovascular Hypertension , presented at the Symposium on Renal Hypertension, Cleveland, October, 1966 .
Nicotero, J.A., et al:  Diagnostic and Physiologic Implications of the Angiotensin Infusion Test , New Eng J Med 274:1464-1468 ( (June 30) ) 1966;.
Connor, T.B., et al:  Hypertension due to Unilateral Renal Disease: With Report on Functional Test Helpful in Diagnosis , Bull Hopkins Hosp 100:241-276 ( (June) ) 1957;.
Judson, W.E., and Helmer, O.M.: " Diagnostic and Prognostic Values " in Rodbard, S., Sapirstein, L.A., and Wood, J.E. (eds.): Hypertension: Proceedings of the Council for High Blood Pressure Research , New York: American Heart Association, 1965;, vol 13, p 79.
Kirkendall, W.M.: Fitz, A.E.; and Lawrence, M.S.:  Renal Hypertension , New Eng J Med 276:479-485 ( (March 3) ) 1967;.
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