T.F. Luscher· N.M. Kaplan (Eds.)

Renovascular and RenalParenchymatous Hypertension

With 219 Figures and 42 Tables

Springer-VerlagBerlin Heidelberg New York London ParisTokyo Hong Kong Barcelona Budapest

Priv.-Doz. Dr. med. Thomas F. LuscherDepartement Innere MedizinKantonsspital BaselPetersgraben 4CH-4031 Basel

Prof. Dr. Norman Mayer KaplanUniversity of Texas Southwestern Medical Center5323 Harry Hines Blvd.Dallas, TX 75 235-8899, USA

ISBN-13:978-3-642-64756-7DOl: 10.1007/978-3-642-61239-8

e- ISBN-13:978-3-642-61239-8

Library of Congress Cataloging-in-Publication Data

Renovascular and renal parenchymatous hypertension / T.F. Luscher, N.M. Kaplan (eds.).p. cm.Includes bibliographical references and index.ISBN-13:978-3-642-64756-71. Renal hypertensiuon. 2. Renovascular hypertension. I. Luscher, Thomas F. (Thomas Felix)II. Kaplan, Norman M., 1931-(DNLM: 1. Hypertension, Renal. 2. Hypertension, Renovascular. WG 340 R4185)RC918.R38R469 1992616.1 '32-<1c20DNLM/DLCfor Library of Congress 91-5229 CIP

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© Springer Verlag, Berlin Heidelberg 1992Softcover reprint of the hardcover 1st edition 1992

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Contents

The Kidney and Hypertension

The Kidney and Regulation of Blood Pressure.I.E. Hall and A.C. Guyton

Glomerular Hemodynamics and Experimental Renal InjuryIA. Benstein and LD. Dworkin

Sodium, the Kidney, and HypertensionN.K. Hollenberg and G.H. Williams . _

Epidemiology and Clinical Importance of Renovascular and RenalParenchymatous HypertensionN.M. Kaplan . _ _

Renovascular Hypertension

3

30

50

63

Pathology and Pathogenesis of Renovascular HypertensionTI Luscher, IT. Lie, and S.G. Sheps . . . . . . . . . . . . . . . 73

Mechanisms of Experimental and Human Renovascular HypertensionF.I Salazar and T. Quesada 107

Vascular Renin-Angiotensin System and Renovascular HypertensionJD. Swales. 137

Angiographical Diagnosis of Renovascular (and Renal Parenchymatous)

HypertensionG. Stuckmann, F. Antonucci, and C. Zollikofer 150

Radioisotope RenographyG. Geyskes .

Noninvasive Assessment of Human Renal Blood Flow by UltrasonicDoppler FlowmetryP.S. Avasthi, K.W. Tawney, and E.R. Greene

179

207

VI Contents

The Renin-Sodium Profile and the Captopril Test as Tools for the Diagnosis ofRenovascular HypertensionFB. Mueller and J.H. Laragh 228

Surgical Management of Main Renal Artery DiseaseLX. von Segesser, F. Largiader, and M. Turina

Surgical Management of Branch Renal Arterial DiseaseA.C. Novick . .

243

259

Percutaneous Transluminal Angioplasty: Technique, Results and ComplicationsT.A. Sos . . . . . . . . . . . . . . . . . . . . . . . . 267

Long-Term Results of Percutaneous Transluminal Renal AngioplastyF. Mahler. . . . .. . . . . . . . . . 299

Medical Therapy of Renovascular and Renal Parenchymatous Hypertension:General PrinciplesI.e. Ferraro, AB. Weder, and AI Zweifler 313

Medical Therapy in Renovascular Hypertension: Angiotensin-ConvertingEnzyme InhibitorsM. Burnier, B. Waeber, I. Nussberger, and HR. Brunner. . . . . . . . . . . . . . . . .. 336

Renal Parenchymatous Hypertension

The Kidney as Target Organ in HypertensionJ.P. Tolins and L. Raij . . 353

Imaging of Renal Parenchymatous HypertensionA.W. Stanson and D.S. Colville .

Sonographic Diagnosis of Renal Hypertension

R.e. Otto... . .

365

392

Magnetic Resonance Imaging and Magnetic Resonance Spectroscopyof the KidneysS. Duewell and G.K. von Schulthess . . . . . . . . . . . . . . . . . . . . . . . . . . 415

Bilateral Kidney Disease and HypertensionD. Malhotra and R.W. Schrier

Diabetes, the Kidney, and Hypertension

C.E. Mogensen .

............. 439

466

Contents VlI

Renal Transplantation, Blood Pressure, and HypertensionE. Guidi and G. Bianchi. . . . . . . . . . . . . . . . . 481

Cyclosporine, Hypertension, and the KidneyD. Diederich, Dai Fu-Xiang, and M. Jameson 497

Unilateral (Curable) Renal Parenchymatous HypertensionC. Wanner and T.F. Luscher 517

Surgical Treatment of Renal Parenchymatous HypertensionE.J. Zingg . . . . . . . . . . . . . . . . . . . . . . . . 546

Subject Index 569

Contributors

Antonucci, F., Abteilung flir Radiologie, Kantonsspital Winterthur, BrauerstraBe 15,CH-8401 Winterthur

Avasthi, P.S., Biomedical Research Division, Lovelace Medical Foundation, 2425Ridgecrest Dr., SE, Albuquerque, NM 87108, USA

Benstein, J.A., Department of Medicine, NYU Medical Center, 550 First Avenue, NewYork, NY 10016, USA

Bianchi, G., Division of Nephrology, Dialysis and Hypertension, Chair of Nephrology,University of Milano, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano

Brunner, H.R., Division d'Hypertension, Centre Hospitalier Universitaire Vaudois, CH­10II Lausanne

Bumier, M., Division d'Hypertension, Centre Hospitalier Universitaire Vaudois, CH­10II Lausanne

Colville, D.S., Division of Hypertension and Internal Medicine, Mayo Clinic and MayoFoundation, 200 First Street, S.W., Rochester, MN 55905, USA

Diederich, D., Division of Nephrology and Hypertension University of Kansas MedicalCenter, 39th & Rainbow Boulevard, Kansas City, KS 66103, USA

Duewell, S., Klinik und Poliklinik fur Nuklearmedizin, Universitiitsspital ZUrich, Riimi­straBe 100, CH-8091 ZUrich.

Dworkin, L.D., Department of Medicine, NYU Medical Center, 550 First Avenue,New York, NY 10016, USA

Ferraro, J., The Medical College of Pennsylvania, Allegheny Campus, Pittsburgh, PAUSA

Fu-Xiang, D., Division of Nephrology and Hypertension University of Kansas MedicalCenter, 39th & Rainbow Boulevard, Kansas City, KS 66103, USA

Contributors IX

Geyskes, G.G., Department of Nephrology, University Hospital Utrecht, Room F03.221, P.O. Box 85500, NL-3508 GA Utrecht

Greene, E.R., Department of Medicine, University of New Mexico, School of Medicine,Albuquerque, NM 87131, USA

Guidi, E., Postgraduate School of Nephrology, University of Milan, Padiglione Granelli,Via Francesco Sforza, 1-20122 Milan

Guyton, A.C., Department of Physiology and Biophysics, University Mississippi Med­ical Center, 2500 North State St., Jackson, MS 39216-4505, USA

Hall, J.E., Department of Physiology and Biophysics, University Mississippi MedicalCenter, 2500 North State St., Jackson, MS 39216-4505, USA

Hollenberg, N.K., Department of Medicine, Brigham and Women's Hospital, 75 FrancisStreet, Boston, MA 02115, USA

Jameson, M., Division of Nephrology, University of Kansas Medical Center, 39th &Rainbow Boulevard, Kansas City, KS 66103, USA

Laragh, J.H., Cardiovascular Center, The New York Hospital, Cornell Medical Center,525 East 68th Street, New Yark, NY 10021, USA

Largiader, F, Department Chirurgie, Klinik fUr Viszeralchirurgie, UniversitatsspitalZiirich, RamistraBe 100, CH-8091 Ziirich

Lie, J.T., Department of Pathology and Division of Cardiovascular Diseases and InternalMedicine, Mayo Clinic and Mayo Foundation, 200 First Street, S.W., Rochester, MN55905, USA

Mahler, F, Abteilung fUr Internistische Angiologie, Medizinische Universitatsklinik,Inselspital Bern, CH-301O Bern

Malhotra, D., Department of Internal Medicine, Division of Renal Diseases, Universityof Colorado, Health Sciences Center, 4200 E 9th Ave., Denver, CO 80262, USA

Mogensen, C.E., Medical Department M, Kommunehospitalet, DK-8000 Aarhus C

Mueller, FB., Cardiovascular Center, The New York Hospital, Cornell Medical Center,525 East 68th Street, New York, NY 10021, USA

Novick, A.C., Department of Urology, Cleveland Clinic Foundation, I Clinic CenterDrive, Cleveland, OH 44195, USA

X Contributors

Nussberger, J., Division d'Hypertension, Centre Hospitalier Universitaire Vaudois, CH­1011 Lausanne

Otto, R., Institut fur Rontgendiagnostik und Nuklearmedizin, Kantonsspital Baden,CH-5404 Baden

Raij, L., Division of Nephrology and Hypertension, Veterans Administration MedicalCenter, 111-J, I Veterans Drive, Minneapolis, MN 55417, USA

Quesada, T., Departamento de Fisiologia y Farmacologia, Universidad de Murcia,30.100 Murcia, Espana

Salazar, FJ., Departamento de Fisiologia y Farmacologia, Universidad de Murcia,30.100 Murcia, Espana

Schrier, R.W., Department oflnternal Medicine, Division ofRenal Diseases, Universityof Colorado, Health Sciences Center, 4200 E 9th Ave., Denver, CO 80262, USA

von Schulthess, O.K., Klinik fUr Nuklearmedizin und Poliklink, UniversitiitsspitalZUrich, RamistraBe 100, CH-8091 ZUrich

von Segesser, LX., Universitatsspital ZUrich, Departement Chirurgie, Klinik fUr Herz­gefaBchirurgie, RamistraBe 100, CH-8091 ZUrich

Sheps, S.G., Divisions ofHypertension and Cardiovascular Diseases and Internal Medi­cine, Mayo Clinic and Mayo Foundation, 200 First Street, S.W., Rochester, MN 55905,USA

Stanson, A.W., Department of Diagnostic Radiology, Mayo Clinic and Mayo Founda­tion, 200 First Street, S.W., Rochester, MN 55905, USA

Stuckmann, G., Abteilung fUr Radiologie, Kantonsspital Winterthur, BrauerstraBe 15,CH-8401 Winterthur

Swales, J.D., Department of Medicine, Clinical Sciences Building, Leicester RoyalInfirmary, P.O. Box 65, Leicester LE2 7LX, UK

Tawney, K.W., Biomedical Research Division, Lovelace Medical Foundation, 2425Ridgecrest Dr., SE, Albuquerque, NM 87108, USA

Tolins, J.P., Division of Nephrology and Hypertension, Veterans Administration Med­ical Center, 111-J, 1 Veterans Drive, Minneapolis, MN 55417, USA

Turina, M., Department Chirurgie, Klinik fUr HerzgefaBchirurgie, UniversitatsspitalZurich, RamistraBe 100, CH-8091 ZUrich

Contributors XI

Waeber, R., Division d'Hypertension, Centre Hospitalier Universitaire Vaudois, CH­10II Lausanne

Wanner, c., Abteilung Innere Medizin, Nephrologie, Medizinische Universitlitsklinik,Hugstetter StraBe 55, 7800 Freiburg i. Br., FRG

Weder, A.B., Department of Internal Medicine, Division of Hypertension, The Univer­sity of Michigan, Medical Center, 3918 Taubman Center, Ann Arbor, MI 48109-0356,USA

Williams, G.H., Department of Radiology, Brigham and Women's Hospital, 75 FrancisStreet, Boston, MA 02115, USA

Zingg, EJ., Abteilung fUr Urologie, Universitat Bern, Inselspital, CH-3010 Bern

Zollikofer, C., Abteilung fUr Radiologie, Kantonsspital Winterthur, BrauerstraBe 15,CH-8401 Winterthur

Zweifler, AJ., Department oflnternal Medicine, Division ofHypertension, The Univer­sity of Michigan, Medical Center, 3918 Taubman Center, Ann Arbor, MI 48109-0356,USA

Preface

Ever since Richard Bright discovered the link between kidney disease and cardiachypertrophy in his pioneering work in 1827, the field of renovascular and renal parenchy­matous hypertension has been a transatlantic adventure. Towards the end of the nine­teenth century, Tigerstedt and Bergman discovered that the kidneys contain a factorwhich raised blood pressure when injected into intact animals. They named the substancerenin, which is now known as the crucial enzyme activating the angiotensin aldosteronesystem, which is so pertinent in the regulation of blood pressure and kidney function.After this crucial European contribution to the field, Harry Goldblatt at the ClevelandClinic demonstrated in his classical experiments that reduction in renal blood flow, byplacing a clamp at the major renal artery, could induce sustained hypertension. Thesediscoveries established the role of the kidney in certain forms of hypertension whichare now classified as renovascular and renal parenchymatous hypertension. Thesefundamental concepts suggested - based on experimental evidence - that restorationof blood flow or nephrectomy in unilateral parenchymatous disease would lead toblood pressure normalization in these patients. Indeed, as early as the first half of thiscentury, a report appeared demonstrating blood pressure normalization in a child withfibromuscular displasia of the right renal artery after nephrectomy. Advances in surgicaltechniques later allowed reconstructive renovascular surgery and therefore a moreappropriate form of therapy of the disease. In the late seventies Andreas Grtinziginitiated another European contribution to renovascular hypertension by introductingthe procedure of percuteaneous transluminal angioplasty, an elegant catheter techniqueallowing non-surgical therapy of renovascular disease. Progress was also made inmedical therapy of renal hypertension, particularly by the development of angiotensinconverting enzyme inhibitors by Ondetti. As it was obvious that activation of the reninangiotensin system plays a crucial role in most forms of renal hypertension, inhibitionof this important pressor system appeared most promising. Indeed, angiotensin convert­ing enzyme inhibitors are now established forms of therapy in renovascular and renalparenchymatous hypertension.It is the purpose of this monograph edited by a European-American team to assemble

a number of pertinent experts in the field of renovascular and renal parenchymatoushypertension to cover all important aspects of the pathology, pathophysiology, diagno­sis, and managment of this important form of secondary hypertension. In the first partof this monograph, several chapters focus on the role of the kidney in blood pressureregulation and the importance of renal disease as a cause of hypertension. Then, thesecond and third major parts of the book are devoted to the pathophysiology, diagnosis,and management ofrenovascular and renal parenchymatous hypertension, respectively.

XIV Preface

Both areas are reviewed by scientists and clinicians from both sides of the Atlantic,thereby reflecting the European-American history of this fascinating disease.

Thomas F. Luscher, MD. Norman M. Kaplan, MD.

Acknowledgement. The authors wish to thank Sabine Bohnert and Amanda de Sola Pinto forinvaluable secretarial assistance and Bernadette Libsig for her assistance with the illustrations.Personal research of the editors reported in this monograph was supported by grants from theSwiss National Research Foundation (No. 3.889--0.86, 32-25468.88 and SCORE-grant No. 3231­025150), the Swiss Cardiology Foundation, and the Helmut Horten Foundation.Thomas F. Liischer would also like to acknowledge the stimulating collaboration and friendshipof Wilhelm Vetter, Peter Greminger, J.T. Lie, Sheldon G. Sheps and Fritz R. Biihler with whomhe had the pleasure to work productively at the University Hospital Ziirich and the UniversityClinics, Kantonsspital Basel, Switzerland and the Mayo Graduate School, Rochester, Minnesota,U.S.A.