[Renovascular hypertension - indications and type of operative method employed]. / Renovaskularna hipertenzija - indikacije i primjenjene operativne metode.

ABSTRACT

The results obtained by surgical treatment are always associated with the correctly established indication for operative treatment of the existing lesion. This is also evident in cases of corrective surgery performed for renovascular hypertension. Therefore, before venturing surgery on renal vessels, with the aim to cure renovascular hypertension, it is necessary to prove that the angiographically verified changes really cause high blood pressure. In order to prove that the functional activity of the renal artery stenosis is the real cause of high blood pressure, we have introduced to our Department a method of renal vein catheterization by which renin activity id determined. In case this method does not show significant difference in renin activity (that is if the renin ratio is lesser than 1.5), the separated examination of kidney function should be performed by ureteral catheterization - the method by Rapoport. Therefore, in undertaking surgical treatment of renovascular hypertension the following criteria are observed increased renin activity in peripheral blood, significantly increased renin activity in renal vein plasma on the side of lesion and the separated examination of renal function which is carried out in case the renal vein catheterization does not give a satisfactory answer. Apart form these, the remaining clinical findings also play an important role. Following these fundamental principles, on the basis of which we make a decision to undertake corrective surgery, we have obtained satisfactory results. This report presents our experience, approach and technique used for corrective operations which we have performed.