Clinical Aspects of Renovascular Hypertension PDF
Preview Clinical Aspects of Renovascular Hypertension
CLINICAL ASPECTS OF RENOVASCULAR HYPERTENSION DEVELOPMENTS IN SURGERY Other titles in this series 1.M. Greep, H.A.l. Lemmens, D.B. Roos, H.C. Urschel, eds., Pain in Shoulder and Arm: An Integrated View ISBN 90 247 2146 6 B. Niederle, Surgery of the Biliary Tract ISBN 90 247 2402 3 1.A. Nakhosteen & W. Maassen, eds., Bronchology: Research, Diagnostic and Therapeutic Aspects ISBN 902472449 X CLINICAL ASPECTS OF RENOVASCULAR HYPERTENSION edited by R van Schilfgaarde, MD Department of Surgery Leiden University Hospital Leiden, The Netherlands J.C. Stanley, MD Department of Surgery University of Michigan Medical School, Ann Arbor MI, U.S.A. P. van Brumme1en, MD Department of Nephrology Leiden University Hospital Leiden, The Netherlands E.H. Overbosch, MD Department of Radiology . Leiden University Hospital Leiden, The Netherlands 1983 MARTINUS NIJHOFF PUBLISHERS a member of the KLUWER ACADEMIC PUBLISHERS GROUP BOSTON / THE HAGUE / DORDRECHT / LANCASTER Distributors for the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street, Hingham, MA 02043, USA for all other countries: Kluwer Academic Publishers Group, Distribution Center, P.O.Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data Main entry under title: Clinical aspects of renovascular hypertension. (Developments in surgery) Includes index. 1. Renal hypertension--Addresses, essays, lectures. 2. Renal hypertension--Surgery--Addresses, essays, lectures. i. Schilfgaarde, R. van (Reinout van) II. Series. [DNLM: 1. Hypertension, Renal--Congresses. Wl DE998s v. 4 I WG 340 C6407 1982] RC9l8.R38C54 1983 616.1'32 83-4193 ISBN-13:978-94-009-6719-9 e-ISBN-13:978-94-009-6717-5 001: 10.1007/978-94-009-6717-5 ISBN-13: 978-94-009-6719-9 Copyright © 1983 by Martinus Nijhoff Publishers, Boston. Softcover reprint of the hardcover 1st edition 1983 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishers, 190 Old Derby Street, Hingham, MA 02043, USA. CONTENTS List of Contributors VII Preface IX 1. P. van Brummelen Renovascular hypertension: Definitions, incidence and clinical aspects 1 2. Ph.J. Hoedemaeker The pathology of reno-vascular hypertension 8 3. J.J. Brown, W.B. Brown, G.P. Hodsman, A.F. Lever, D. McAreavey, J.J. Morton, E.C.M. Wallace and J.I.S. Robertson Renovascular hypertension: Aspects of pathophysiology 17 4. E.H. Overbosch, E.K.J. Pauwels, M. Oudkerk and J.G. Blickmann Radiodiagnostic investigations for renovascular hyper- tension 27 5. B.J. Hillman Digital subtraction, angiography in the evaluation of hypertension 46 6. M.A.D.H. Schalekamp and F.H.M. Derkx Functional diagnosis of renovascular hypertension, with special reference to renin measurements 62 7. M.H. Maxwell and A.U. Waks Application of diagnostic procedures in patient manage- ment 74 8. W.H. Birkenhager and P.W. de Leeuw General aspects of medical treatment. A review 95 9. G.J. wenting, H.L. Tan Tjiong, F.H.M. Derkx, H. van Urk, J.H.B. de Bruyn and M.A.D.H. Schalekamp captopril in the treatment of hypertension with renal artery stenosis 107 10. J.C. Stanley Renovascular hypertension: Basis for anatomical recon- struction 120 11. J.L. Terpstra and R. van Schilfgaarde In situ and extracorporeal reconstruction: Technical aspects of surgical therapy for renovascular hyper- tension 138 12. R. van Schilfgaarde, J.H. van Bockel, W. Felthuis and J.L. Terpstra Clinical results of surgical therapy for renovascular hypertension 150 13. R.J.A.M. van Dongen Renovascular hypertension: Combined surgical procedures 170 VI 14. J.H. van Bockel, A. van Es, R.A.M.G. Donckerwolcke, G.G. Persijn, R. van Schilfgaarde and J.L. Terpstra Renal artery stenosis in kidney transplantation 183 15. G.B.A.J. Puijlaert Technical aspects of transluminal angioplasty in renal arteries 209 16. G.G. Geyskes Follow-up study of 70 patients with renal artery stenosis treated by percutaneous trans luminal dila- tation 225 17. C.E. Grim, H.Y. Yune, J.P. Donahue, M.H. Weinberger, R. Dilly and E.C. Klatte Treatment of renal vascular hypertension: A compari son of patients treated by surgery or by percutaneous trans luminal angioplasty 238 18. C.E. Grim Renovascular hypertension: The medical point of view 243 19. J.C. Stanley Renovascular hypertension: The surgical point of view 259 Index of subjects 269 LIST OF CONTRIBUTORS Birkenhager, W.H., Department of Internal Medicine, Zuiderziekenhuis, Groene Hilledijk 315, 3075 EA Rotterdam, The Netherlands Blickman, J.G., Department of Radiology, Leiden University Hospital, Rijns burgerweg 10, 2333 AA Leiden, The Netherlands Bockel van, J.H., Department of Surgery, Leiden University Hospital, Rijns burgerweg 10, 2333 AA Leiden, The Netherlands Brown, J.J., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Brown, W.B., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Brummelen van, P., Department of Nephrology, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands De Bruyn, J.H.B., Department of Internal Medicine I, University Hospital Dijkzicht, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands Derkx, F.H.M., Department of Internal Medicine I, University Hospital Dijk zicht, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands Dilly, R., Department of Urology, Indiana University School of Medicine, Clinical Building 477, 1100 West Michigan Street, Indianapolis IN 46223, USA Donahue, J.P., Department of Urology, Indiana University School of Medicine, Clinical Building 477, 1100 West Michigan Street, Indianapolis IN 46223, USA Donckerwolcke, R.A.M.G., Wilhelmina Children's Hospital, University of Utrecht, Nieuwe Gracht 137, 3512 LK Utrecht, The Netherlands Dongen van, R.J.A.M., Department of Vascular Surgery, University Hospital Wilhelmina Gasthuis, Eerste Helmersstraat 104, 1054 EG Amsterdam, The Netherlands Es van, A., Department of Nephrology, Leiden University Hospital, Rijnsbur gerweg 10, 2333 AA Leiden, The Netherlands Felthuis, W., Department of Surgery, Leiden University Hospital, Rijnsbur gerweg 10, 2333 AA Leiden, The Netherlands Geyskes, G.G., Department of Nephrology and Hypertension, University Hospi tal, P.o. Box 16250, 3500 CG Utrecht, The Netherlands Grim, C.E., Department of Medicine, Hypertension Research Center, Indiana University School of Medicine, Clinical Building 477, 1100 West Michigan street, Indianapolis IN 46223, USA Hillman, B.J., Department of Genitourinary Radiology, University of Arizona Health Science Center, Tucson AZ 85724, USA Hodsman, G.P., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Hoedemaeker, Ph.J., Department of Pathology, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands VIII Klatte, E.C., Department of Radiology, Indiana University School of Medi cine, Clinical Building 477, 1100 West Michigan Street, Indianapolis IN 46223, USA Leeuw de, P. W., Department of Internal Medicine, Zuiderziekenhuis, Groene Hilledijk 315, 3075 EA Rotterdam, The Netherlands Lever, A.F., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Maxwell, M.H., Hypertension Services, Cedars-Sinai and UCLA Medical Cen ters, Cedars-Sinai Medical Center, Box 48750, Los Angeles, CA 90048, USA McAreavey, D., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Morton, J.J., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6N'l', Scotland, United Kingdom Oudkerk, M., Department of Radiology, Leiden University Hospital, Rijnsbur gerweg 10, 2333 AA Leiden, The Netherlands Overbosch, E.H., Department of Radiology, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands Pauwels, E.K.J., Division of Nuclear Medicine, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands Persijn, G.G., Eurotransplant Foundation, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands Puijlaert, C.B.A.J., Department of Radiology, University Hospital, P.O. Box 16250, 3500 GD Utrecht, The Netherlands Robertson, J.I.S., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Schalekamp, M.A.D.H., Department of Internal Medicine I, University Hospi tal Dijkzicht, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands Schilfgaarde van, R., Department of Surgery, Leiden University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands Stanley, J.C., Department of Surgery, University of Michigan Medical School, 1405 E. Ann Street, Ann Arbor MI 48109, USA Tan Tjiong, H.L., Department of Internal Medicine I, University Hospital Dijkzicht, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands Terpstra, J.L., Department of Surgery, Leiden University Hospital, Rijns burgerweg 10, 2333 AA Leiden, The Netherlands Urk van, H., Department of Surgery, University Hospital Dijkzicht, Dr.Mole waterplein 40, 3015 GD Rotterdam, The Netherlands Waks, A.U., Hypertension Services, Cedars-Sinai and UCLA Medical Centers, Cedars-Sinai Medical Center, Box 48750, Los Angeles, CA 90048, USA Wallace, E.C.M., MRC Blood Pressure Unit, Western Infirmary, Glasgow GIl 6NT, Scotland, United Kingdom Weinberger, M.H., Department of Medicine, Hypertension Research Center, Indiana University School of Medicine, Clinical Building 477, 1100 West Michigan Street, Indianapolis IN 46223, USA Wenting, G.J., Department of Internal Medicine I, University Hospital Dijk zicht, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands Yune, H.Y., Department of Radiology, Indiana University School of Medicine, Clinical Building 477, 1100 West Michigan Street, Indianapolis IN 46223, USA Preface Diagnostic and therapeutic methods and controversies in the management of renovascular hypertension have undergone major chan- ges during the past few years. This book is based on the proceedings of a successful postgraduate Boerhaave Course held in 1982 at the Faculty of Medicine of the University of Leiden, The Netherlands. Current concepts concerning the diagnosis and treatment of reno vascular hypertension were presented during this course to an audience composed of physicians, nephrologists, cardiologists, surgeons, uro logists, and radiologists. Thus, this book aims at offering an overview of tho,se aspects of renovascular hypertension which are relevant to clinical prac- tice. An effort is made to review the currently available moda lities of diagnostic procedures, both on the basis of modern in sights in the pathology and pathophysiology of renovascular hyper tension, as well as timely r'esul ts of clinical research. In ad dition, several chapters deal with combinations of these diag- nostic procedures in a fashion that can be of practical help in clin;cal decision making. The medical, surgical and angioplastic modalities of treatment are reviewed. Basic considerations concerning medical treatment and technical aspects of surgical as well as per cutaneous angioplasty are presented in detail, both separately and in combination. Special attention is given to the problem of renal artery stenosjs in k~dney transplants. This book offers up to date information on clinical aspects of renovascular hypertension, useful to a wide range of clinicians in a variety of disciplines. We hope that it will contribute to further improvements in the management of patients with reno vascular hypertension. The effort taken by all authors in contributing to the book, is gratefully acknowledged. We want to specially thank Mrs. Cathy Fung Kim, who performed a large amount of work in preparing the manu scripts. Reinout van Schilfgaarde James C. Stanley Peter van Brummelen ,Evert H. Overbosch 1. RENOVASCULAR HYPERTENSION: DEFINITIONS, INCIDENCE AND CLINICAL ASPECTS. P. VAN BRUMMELEN 1. DEFINITIONS' Renovascular hypertension is defined as high blood pres sure caused by occlusive disease of the renal arterial vasculature which is potentially curable by correction of the lesion(s) (1). Renovascular hypertension is not iden tical with renal artery stenosis since it has been recogni zed for a long time that the latter is not necessarily accompanied by an elevated blood pressure. Indeed, in a study reported by Eyler et al. (2) it was shown that 102 of 303 normotensive patients had some degree of renal arterial narrowing on arteriography. This observation was confirmed by two later studies based on autopsy data (3,4). Especially in the older age groups a sizable number of atherosclerotic renovascular lesions is encountered (2). To separate this entity from renovascular hypertension, as defined above, the term renovascular disease is often used. It should, however, be noted that the same term is also used for another group of patients i. e. those hypertensive patients with a renal artery stenosis which is not the cause of the elevated blood pressure. Renovascular disease in normotensive patients is usually discovered by chance, either in the course of an angiogra phic investigation or at autopsy. In the majority of pa tients it does not constitute a clinical problem. Renal function can be impaired in patients with severe bilateral stenoses, but this seems to be extremely rare in the absence of a high blood pressure.
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