Measurement of renin in segmental renal veins of hypertensives

In 27 of 270 patients studies for possible renovascular hypertension, a lesion affecting a segmental renal artery was seen on angiography. In 22 patients who had sufficient data, the significance of measuring segmental-renal-vein renin in the diagnosis and treatment of segmental disease was evaluated. In 11 (50%), the renin values of segmental vessels supported the clinical diagnosis. In four (36%) of these 11, a high-renin-release area would not have been identified without the stress of upright posture. Successful treatment of hypertension was achieved in six of nine patients who had a revascularization procedure or resection of the segmental vessels. Samples from involved and uninvolved segments of the kidney as well as from the contralateral renal vein and inferior vena cava, together with the stimuli of sodium and volume depletion augmented by upright posture, enabled confirmation of the angiographic diagnosis of segmental-renovascular hypertension.