saralasin and Fibromuscular-Dysplasia

Topics: Adolescent; Adult; Age Factors; Animals; Arteriosclerosis; Bradykinin; Female; Fibromuscular Dysplasia; Humans; Hypertension, Renal; Hypertension, Renovascular; Ischemia; Kidney; Kidney Function Tests; Kidney Transplantation; Male; Prostaglandins; Radiography; Renal Artery; Renal Artery Obstruction; Renin; Renin-Angiotensin System; Saralasin; Sex Factors

Topics: Adult; Antihypertensive Agents; Aortography; Arteries; Arteriosclerosis; Blood Vessel Prosthesis; Child; Endarterectomy; Fibromuscular Dysplasia; Humans; Hypertension, Renal; Hypertension, Renovascular; Kidney; Middle Aged; Nephrectomy; Radioisotope Renography; Renal Artery; Renin; Replantation; Saralasin; Splenic Artery; Teprotide; Transplantation, Autologous; Veins

Eleven cases of renovascular hypertension treated by the authors during the 10-year period from 1974 to 1984 are summarized in this paper, referring particularly to its etiology and prognosis. The causative diseases included 3 cases of atherosclerosis, 4 cases of fibromuscular dysplasia, 1 case of aortitis syndrome, 1 case of abdominal aneurysm, 1 case of renovascular thrombosis, and 1 case of unknown origin. Operations were given in 10 of the 11 cases i.e., 7 cases of nephrectomy and 3 cases of reconstructive surgery for renal blood-flow. The results of operations at discharge were 7 cases of blood pressure normalization, 2 cases of its improvement and 1 case of no change. There was no operative mortality. The outcome of long followup revealed that 2 of the 3 patients with atherosclerosis died in 9 months and 1 year and 10 months, respectively, due to cerebral hemorrhage and renal failure. However, the patients with other diseases maintained their health for 5 years and 5 months (mean observation period), with normal blood pressure or a mild hypertension. Sometimes, in patients with atherosclerosis in whom severe arteriosclerotic lesions already exist in the cardiovascular system, conservative therapy is better than surgical therapy. The indication for surgical therapy, should be made after considering the results of the angiotensin II analogue test.

Topics: Adolescent; Adult; Aorta, Abdominal; Aortic Aneurysm; Aortitis; Arteriosclerosis; Child; Child, Preschool; Female; Fibromuscular Dysplasia; Humans; Hypertension, Renovascular; Infant; Male; Prognosis; Saralasin

The usefulness of screening patients for renovascular hypertension by infusion of saralasin, a competitive antagonist of angiotensin II, was evaluated. Responses were compared in 19 patients with proved renovascular hypertension and in 34 without renovascular hypertension, as indicated by renal arteriography and renal venous renin studies. Saralasin infusion was carried out in the morning after furosemide, 80 mg by mouth, had been given the previous evening. Seventy-five percent of patients with and 12 percent of those without renovascular hypertension had a reduction in diastolic pressure of 5 mm Hg or more during saralasin infusion; only 45 percent of patients with and 6 percent of those without renovascular hypertension had a reduction of 10 mm Hg or greater during infusion. In comparison, 80 percent of patients with and 18 percent of those without renovascular hypertension had a positive intravenous pyelogram. The predictive value of a positive saralasin test (5 mm Hg or greater reduction in diastolic pressure) was calculated for varying prevalence rates of renovascular hypertension with use of Bayes theorem. The results indicate that when the prevalence rate of renovascular hypertension among hypertensive patients is 5 percent only 25 percent of positive saralasin tests will correctly predict its presence.

Topics: Adolescent; Adult; Aged; Angiotensin II; Arteriosclerosis; Blood Pressure; Child; Female; Fibromuscular Dysplasia; Humans; Hypertension, Renal; Hypertension, Renovascular; Male; Middle Aged; Renal Artery Obstruction; Renin; Saralasin; Urography