Renal artery stenosis with resultant
renovascular hypertension has attracted clinical attention because the disease is potentially curable and because numerous diagnostic and therapeutic modalities compete for clinical acceptance. An exercise-mediated disturbance of renal
hippurate transport was recently described, and has been implicated as having a role in nephrogenic fixed
hypertension. To predict the final course of
renovascular hypertension before operation we carried out a prospective study with the goal of verifying the predictive value of exercise
hippurate scintigraphy. The study was to test the hypothesis that patients with disturbance of renal
hippurate transport (pathologic renogram) induced by exercise would have stabilized
hypertension and would continue to be hypertensive after operation. Thirty-one patients with
hypertension who had unilateral or bilateral renovascular
stenosis documented on angiography were referred to rest and exercise
hippurate scintigrams before operation. The results of the examinations at rest served as standard and were compared with the exercise scintigrams. In 19 of the 31 (61%) patients a disturbance of transrenal
hippurate transport evolved during exercise, whereas 12 (39%) patients failed to respond to exercise with altered
hippurate kinetics. Twenty-six patients went on to renovascular operations; five had percutaneous transluminal angioplasty. Revascularization results differed markedly when the blood pressure response of patients with positive results on exercise (abnormal) and patients with negative results on exercise (normal) were compared. Ten of 12 patients with
hypertension who had normal exercise renograms were cured. In comparison, blood pressure values were little influenced by
therapy in patients with an abnormal response, where 17 of 19 patients continued to have hypertensive disease after
therapy.(ABSTRACT TRUNCATED AT 250 WORDS)