GLOMERULAR HYPERTENSION IN RENOVASCULAR HYPERTENSIVE PATIENTS

Split intrarenal hemodynamics in stenotic and contralateral kidneys of unilateral renovascular hypertension (RVH) were estimated by Gomez's formulae. Forty patients with essential hypertension and 40 patients with RVH were studied. Split para-amino hippurate and inulin clearances were measured by ureteral catheterization as indexes for effective renal plasma flow and glomerular filtration rates, allowing the estimation of intrarenal hemodynamics such as afferent arteriolar resistance (R(A)), efferent arteriolar resistance (R(E)) and glomerular hydrostatic pressure (P(G)) in each kidney. Normal values of intrarenal hemodynamic parameters were obtained in 24 normotensive subjects without ureteral catheterization, assuming each kidney had the half function of both kidneys. Systemic mean arterial pressure did not differ between essential and renovascular hypertension (141 +/- 3 vs. 148 +/- 3 mm Hg). Effective renal plasma flow and glomerular filtration rates were decreased in the stenotic kidney of RVH (98 +/- 8, 24 +/- 2 ml/min/m2), while increased in the contralateral kidney (195 +/- 11, 48 +/- 2), compared with the right kidney of essential hypertension (162 +/- 8, 33 +/- 1). Although effective renal plasma flow rate was not different from normal (191 +/- 8), glomerular filtration rate was significantly higher in the contralateral kidney of RVH than in normal (38 +/- 1). R(A) was elevated due to the stenotic lesion in the stenotic kidney (28,500 +/- 1,900 dyns . sec . cm-5), while the elevation in the contralateral kidney (10,800 +/- 600) was less than in the right kidney of essential hypertension (14,900 +/- 1,200). R(E) (5,800 +/- 300) in both kidneys of RVH was higher than in the right kidney of essential hypertension (4,500 +/- 200). P(G) was lowered in the stenotic kidney (57 +/- 1 mm Hg), while elevated in the contralateral kidney (74 +/- 1), compared with the right kidney of essential hypertension (63 +/- 1). The elevation in P(G) in the contralateral kidney, being significant compared to normal (66 +/- 1), was correlated with systemic mean arterial pressure. Although the stenotic kidney of RVH was protected from systemic hypertension by stenosis of the renal artery, the increase in R(A) in the contralateral kidney was not sufficient, resulting in an elevated P(G). Thus, glomerular hypertension and hyperfiltration were demonstrated in the contralateral kidney of RVH.