Renal Vein Renin Concentration in the Hypertension of Unilateral Reflux Nephropathy

Abstract

Hypertension is a frequent complication of reflux nephropathy. The cause of this hypertension is unknown. Our study was undertaken to assess the possible role of the renin-angiotensin system in the hypertension associated with unilateral reflux nephropathy. We selected for study 17 normotensive and 12 hypertensive patients with strictly unilateral reflux nephropathy. There were 3 normotensive and 2 hypertensive patients with a renal vein renin ratio exceeding 1.5. Of these 3 normotensive patients 1 had evidence from divided renal function studies to suggest functional renal ischemia. No consistent evidence was obtained to support the concept that the renin-angiotensin system has a primary role in the non-malignant hypertension of unilateral reflux nephropathy.

Vesicoureteral Reflux, a Scarred kidney, and Minimal Proteinuria: An Unusual Cause of Adult Secondary Hypertension

“…In children, it has been shown that patients with VUR have high circulating or selective renal vein renin levels [10]. One study suggested no consistent evidence to support the role of renin-angiotension and hypertension in patients with unilateral reflux nephropathy [18]. Another study showed upregulation of angiotensin II receptors in reflux nephropathy [19].…”

Unilateral Renal Disease and Hypertension

“…Hypertension was reported in 10 of 45 patients studied pathologically by Kincaid-Smith [7], and Bailey et al [9] reported a diastolic blood pressure above 90 mm Hg in 12 of 29 patients with unilateral reflux nephropathy. Atrophic pyelonephritis secondary to reflux and recurrent infection may be an important cause of juvenile hypertension [10,11], The hypertension usually responds to resection of the involved kidney or pole [11][12][13], However, despite the postresection fall in blood pressure, peripheral renins are usually [9,12,14], but not always [10,11], within normal limits.…”

“…Atrophic pyelonephritis secondary to reflux and recurrent infection may be an important cause of juvenile hypertension [10,11], The hypertension usually responds to resection of the involved kidney or pole [11][12][13], However, despite the postresection fall in blood pressure, peripheral renins are usually [9,12,14], but not always [10,11], within normal limits. Moreover, the renal vein renin activity is frequently normal and with a disease/ normal (D/N) ratio below 1.5 in half or more of the hyper tensive patients [9,10,14], while the D/N ratio may be above 1.5 in some normotensive or less than 1.0 in some hypertensive patients. A partial explanation for a renindependent hypertension based on a positive saralasin test was offered by studies of 2 patients with unilateral seg mental atrophy by Javadpour et al [12].…”

Reflux nephropathy and hypertension

“…In a study of 17 normotensive and 12 hypertensive patients with strictly unilateral nephropathy, there were only three normotensive and two hypertensive patients with a renal vein renin ratio exceeding 1.5, indicating that the reninangiotensin system may not consistently have a role in the hypertension of unilateral reflux nephropathy. 117 On the other hand it could be argued that in the normotensive unilateral scarred kidney patients with a renal vein renin ratio of more than 1.5 the non-scarred kidney must be normal as opposed to 'apparently' normal and responds to the effects of increased blood pressure by natriuresis ultimately producing normotension.…”