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ARTICLE |

Malignant Hypertension Following Renal Artery Branch Obstruction: Title and subTitle BreakEvidence for High Renin Production From the Ischemic Area FREE

Gysbert G. Geyskes, MD; John R. Misage, MD; Klaus Bron, MD; Joel E. Haas, MD; George Berg, MD; Alvin P. Shapiro, MD
[+] Author Affiliations

Reprint requests to the Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh (Dr. Shapiro).


JAMA. 1972;222(4):457-459. doi:10.1001/jama.1972.03210040029008
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Occlusion of a renal artery branch with subsequent partial renal infarction resulted in high renin production from the ischemic part of the kidney and malignant hypertension. Absence of overall ischemia from the affected kidney prevented development of a pattern of increased concentration of nonabsorbable solutes (ie, creatinine and para-aminohippuric acid), although total urine flow was decreased by reduction of renal excretory mass. Renin activity was at least tenfold higher in the ischemic area than in the normal kidney and manifested itself clinically by a 1.7 to 1 difference in the preoperative renal vein renin values between the affected and nonaffected kidneys. Removal of the affected kidney resulted in a "cure" of the malignant hypertension.

REFERENCES

Boucher R, Veyrat R, de Champlain J, et al:  New procedures for measurement of human plasma angiotensin and renin activity levels . Canad Med Assoc J 90:194-201, 1964;.
Istkovitz HD, Hildreth EA, Sellers AM, et al:  The granularity of the juxtaglomerular cells in human hypertension: Histologic and clinical correlations . Ann Intern Med 59:8-23, 1963;.
Gross F, Lichtlen P:  Pressor substances in kidneys of renal hypertensive rats with and without adrenals . Proc Soc Exp Biol Med 98:341-345, 1958;.
Loomis D:  Hypertension and necrotizing arteritis in the rat following renal infarction . Arch Path 41:231-268, 1946;.
Masson GMC, Yagi S, Kashii C, et al:  Further observations on juxtaglomerular cells and renal pressor activity in experimental hypertension . Lab Invest 13:321-330, 1964;.
McDonald RT, Szilagyi DE, Smith RF:  Nephrogenic hypertension (Goldblatt kidney) following operative trauma to the renal artery . Circulation 18:71-75, 1958;.
Page IH, McCubbin JW: Renal Hypertension . Chicago, Yearbook Medical Publishers Inc, 1968;, p 3241.
Genest J, Tremblay GY, Boucher R, et al:  Diagnostic significance of humoral factors in renovascular hypertension , in Gross F (ed.): Antihypertensive Therapy, Principles and Practice . Berlin, Springer-Verlag, 1966;, pp 518-540.
Blaine EH, Davis JO, Witty RT:  Renin release after hemorrhage and after suprarenal aortic constriction in dogs without sodium delivery to the macula densa . Circ Res 27:1081-1089, 1970;.
Richardson JR, Hagedorn CW, Hartley BJ, et al:  The function of the individual kidneys in hypertension of renal vascular origin . J Lab Clin Med 65:49-63, 1965;.
Fair WR, Stamey TA:  Differential renal function studies in segmental renal ischemia . JAMA 217:790-793, 1971;.

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Boucher R, Veyrat R, de Champlain J, et al:  New procedures for measurement of human plasma angiotensin and renin activity levels . Canad Med Assoc J 90:194-201, 1964;.
Istkovitz HD, Hildreth EA, Sellers AM, et al:  The granularity of the juxtaglomerular cells in human hypertension: Histologic and clinical correlations . Ann Intern Med 59:8-23, 1963;.
Gross F, Lichtlen P:  Pressor substances in kidneys of renal hypertensive rats with and without adrenals . Proc Soc Exp Biol Med 98:341-345, 1958;.
Loomis D:  Hypertension and necrotizing arteritis in the rat following renal infarction . Arch Path 41:231-268, 1946;.
Masson GMC, Yagi S, Kashii C, et al:  Further observations on juxtaglomerular cells and renal pressor activity in experimental hypertension . Lab Invest 13:321-330, 1964;.
McDonald RT, Szilagyi DE, Smith RF:  Nephrogenic hypertension (Goldblatt kidney) following operative trauma to the renal artery . Circulation 18:71-75, 1958;.
Page IH, McCubbin JW: Renal Hypertension . Chicago, Yearbook Medical Publishers Inc, 1968;, p 3241.
Genest J, Tremblay GY, Boucher R, et al:  Diagnostic significance of humoral factors in renovascular hypertension , in Gross F (ed.): Antihypertensive Therapy, Principles and Practice . Berlin, Springer-Verlag, 1966;, pp 518-540.
Blaine EH, Davis JO, Witty RT:  Renin release after hemorrhage and after suprarenal aortic constriction in dogs without sodium delivery to the macula densa . Circ Res 27:1081-1089, 1970;.
Richardson JR, Hagedorn CW, Hartley BJ, et al:  The function of the individual kidneys in hypertension of renal vascular origin . J Lab Clin Med 65:49-63, 1965;.
Fair WR, Stamey TA:  Differential renal function studies in segmental renal ischemia . JAMA 217:790-793, 1971;.
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