Assuntos
Angiotensina II/metabolismo , Hipertensão/etiologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Diagnóstico Diferencial , Estudos de Avaliação como Assunto , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/metabolismo , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/metabolismo , Masculino , Pessoa de Meia-Idade , Grupos Raciais , Radiografia , Renina/sangue , Saralasina/efeitos adversosRESUMO
Renal vein renin ratios from 56 hypertensive patients who were operated upon for unilateral stenosis of a main renal artery were compared to blood pressure response to a corrective operation. In patients with renal vein renin ratios greater then 2.0, the upper limits of normal for essential hypertension (95 per cent confidence limits), the cure/improvement rate approximated 90 per cent. However, in patients operated upon despite lesser ratios the cure/improvement rate was also high--83 per cent in our series and 57 per cent in collected reports from the literature. Thus, the test may be falsely negative in a high percentage of patients. Renal vein renin ratios would appear to be most useful in confirming but not necessarily in denying the functional significance of a renal artery stenosis.
Assuntos
Hipertensão Renal/cirurgia , Obstrução da Artéria Renal/cirurgia , Veias Renais , Renina/sangue , Adulto , Feminino , Humanos , Hipertensão Renal/etiologia , Masculino , Obstrução da Artéria Renal/complicações , Renina/fisiologia , Estudos RetrospectivosAssuntos
Hipertensão Renal , Adulto , Angiografia , Feminino , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/diagnóstico por imagem , Hipertensão Renal/cirurgia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Prospectivos , Renografia por Radioisótopo , Artéria Renal/cirurgia , Obstrução da Artéria Renal/diagnóstico , UrografiaRESUMO
A frequency distribution curve and interval percentages of variations in right versus left renal vein renin (RVR) were calculated from 227 sets of renin data from patients with mild and moderate essential hypertension (EH). A renal vein renin ratio (RVRR), large/small, of approximately 2.0 or more falls beyond the 95 per cent confidence interval, and may therefore by considered to be abnormal. Although assay variability and sampling errors may contribute to artifactually large RVRR's in EH, they usually indicate true disparity, probably secondary to asymmetrical nephrosclerosis. Recent hypotheses regarding diagnostic value of RVR in hypertension are evaluated in light of data yielded by this investigation. Simultaneous and/or replicate sampling should reduced within-patient variability and improve clinical interpretation of test results.
Assuntos
Hipertensão/sangue , Veias Renais , Renina/sangue , Adulto , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Radioimunoensaio , Veia Cava InferiorRESUMO
The sensitivity and specificity of the hypertensive intravenous pyelogram and the iodohippuran renogram have been determined for the diagnosis of renovascular disease, and cost-effectiveness calculations have been made for the diagnosis and surgical treatment of patients with renovascular hypertension. When the intravenous pyelogram alone is used to screen representative hypertensive population, 78 per cent of patients with renovascular disease are located, but at the same time an equal number of patients without renovascular diasease have abnormal pyelograms. The renogram, on the other hand, is associated with varying true-positive and false-positive ratios. These data can be plotted in the form of a receiver-operating-characteristic curve. The cost of finding a patient with renovascular disease is about $2,000, and that of a surgical cure is about $20,000. The number of deaths for 100 surgical cures is approximately 15. The dollar cost of screening and treating the total American renovascular hypertensive population is of the order of 10 to 13 billion dollars.
Assuntos
Custos e Análise de Custo , Hipertensão Renal/diagnóstico , Renografia por Radioisótopo , Urografia , Teorema de Bayes , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Hipertensão Renal/mortalidade , Hipertensão Renal/cirurgia , Ácido Iodoipúrico , Estados UnidosRESUMO
There were 104 major complications (13.1%) and 34 deaths (5.9%) among 502 patients with evidence of renovascular disease who underwent 577 operative procedures. The operative mortality rate in patients with atherosclerotic renovascular disease was 9.3% vs 3.4% with fibromuscular hyperplasia. Important determinants of renovascular operative mortality are (1) cause of disease, (2) presence of coronary artery disease, (3) presence of bilateral renal functional impairment, (4) the complexity of the renal operative procedure, and (5) concurrent extrarenal surgery.