Document Detail

Renovascular hypertension: a perfusion disturbance that escaped recognition.
MedLine Citation:
PMID:  8418270     Owner:  NLM     Status:  MEDLINE    
A bilateral, exercise-mediated, hippurate transport disturbance was previously described when patients with fixed renovascular hypertension were imaged with o-iodo-hippurate. This study sought to test the hypothesis that patients with an abnormal exercise scintigram have a perfusion abnormality characterized by dysregulation of renal blood flow. We imaged 23 patients with hypertension and angiographically documented renovascular disease in the supine position, as well as during upright exercise. Seven normotensive volunteers served as controls. We measured the resting glomerular filtration rate (GFR) and the effective renal plasma flow (ERPF) with a single compartment radiotracer infusion clearance. The clearance examination also included a measurement period with 25 watt ergometric exercise. Nine hypertensive patients had normal exercise renograms. These patients had age-appropriate clearance values at rest and during exercise, as well as age-appropriate best-organ (generally without stenosis) GFR and ERPF values. The filtration fraction (FF) was 0.21 at rest and 0.22 during exercise. Fourteen hypertensive patients had a bilateral, exercise-induced disturbance of hippurate transport. In these patients, the global resting GFRs and ERPFs were decreased 40% from age-appropriate predicted values. The FF remained at 0.20. Light exercise caused a pronounced contraction of GFR and a less severe reduction in the ERPF. During exercise the mean filtration fraction was only 0.12. The exercise-induced reduction in the clearance values was bilateral, which indicated that the perfusion of nonstenosed organs was compromised as well. We suggest that the described perfusion abnormality occupies a relevant position during the maintenance phase of fixed renovascular hypertension.
J H Clorius; F Reinbold; T Hupp; A Mandelbaum; P Schmidlin; G van Kaick
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  34     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  1993 Jan 
Date Detail:
Created Date:  1993-02-03     Completed Date:  1993-02-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  48-56     Citation Subset:  IM    
Department of Oncologic Diagnosis and Therapy, German Cancer Research Center, Heidelberg.
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MeSH Terms
Glomerular Filtration Rate
Hypertension, Renovascular / physiopathology*,  radionuclide imaging
Middle Aged
Physical Exertion
Radioisotope Renography
Renal Circulation*

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