Abstract
Renovascular disease irrespective of the cause activates multiple pressor systems, most specifically the renin-angiotensin-aldosterone system (RAAS). This complex hormone system exerts several renal and vascular effects, and seminal studies have outlined the sentinel importance of this system in the context of renovascular disease. Experiments using Goldblatt’s classic 2 kidneys-1-clip model generate the prototype of angiotensin-dependent hypertension (Laragh, Am J Hypertens 4:541S–545S, 1991; Pickering, Semin Nucl Med 19:79–88, 1989). In humans, numerous methods to assess the levels of these hormones in the plasma have been proposed to characterize the hemodynamic significance of renovascular disease and to provide guidance on who will benefit of revascularization. However, in recent years, many of these diagnostic methods have been abandoned due to complex work-up, relatively low sensitivity and specificity, and the advent of more reliable non-invasive imaging techniques (Covic and Gusbeth-Tatomir, Prog Cardiovasc Dis 52:204–208, 2009). Although one could argue that the pressure in identifying the pressors roles has decreased, since preservation of function has become the most predominant argument, still, characterization of the RAAS system is important since it may provide useful additional information, including those for important therapeutic decisions.
Several screening laboratory tests have been proposed over the years to identify patients with renovascular hypertension. Some of these studies remain based on the identification of the activation of the RAAS system and some may depend on the comparison of the kidneys side-by-side assuming that one kidney is not affected. However, even under the best conditions, these studies are rarely more than 80 % sensitive or specific. As a result, their value as predictors depends greatly on the pretest probability of renovascular disease. Moreover, functional tests are heavily dependent upon test conditions, including volume status, sodium intake and antihypertensive medications, which can affect levels of this complex hormone system.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Laragh JH. On the mechanisms and clinical relevance of one-kidney, one-clip hypertension. Am J Hypertens. 1991;4:541S–5.
Pickering TG. Renovascular hypertension: etiology and pathophysiology. Semin Nucl Med. 1989;19:79–88.
Covic A, Gusbeth-Tatomir P. The role of the renin-angiotensin-aldosterone system in renal artery stenosis, renovascular hypertension, and ischemic nephropathy: diagnostic implications. Prog Cardiovasc Dis. 2009;52:204–8.
Garovic V, Textor SC. Renovascular hypertension: current concepts. Semin Nephrol. 2005;25:261–71.
De Bruyne B, Manoharan G, Pijls NH, et al. Assessment of renal artery stenosis severity by pressure gradient measurements. J Am Coll Cardiol. 2006;48:1851–5.
Drieghe B, Madaric J, Sarno G, et al. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. Eur Heart J. 2008;29:517–24.
Canzanello VJ, Textor SC. Noninvasive diagnosis of renovascular disease. Mayo Clin Proc. 1994;69:1172–81.
Herrmann SM, Textor SC. Diagnostic criteria for renovascular disease: where are we now? Nephrol Dial Transplant. 2012;27:2657–63.
Wilcox CS. Use of angiotensin-converting-enzyme inhibitors for diagnosing renovascular hypertension. Kidney Int. 1993;44:1379–90.
Egan BM, Basile JN, Rehman SU, et al. Plasma renin test-guided drug treatment algorithm for correcting patients with treated but uncontrolled hypertension: a randomized controlled trial. Am J Hypertens. 2009;22:792–801.
Derkx FH, Schalekamp MA. Renal artery stenosis and hypertension. Lancet. 1994;344:237–9.
Pedersen EB. Angiotensin-converting enzyme inhibitor renography. Pathophysiological, diagnostic and therapeutic aspects in renal artery stenosis. Nephrol Dial Transplant. 1994;9:482–92.
Mann SJ, Pickering TG, Sos TA, et al. Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. Am J Med. 1991;90:30–40.
Vasbinder GB, Nelemans PJ, Kessels AG, Kroon AA, de Leeuw PW, van Engelshoven JM. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med. 2001;135:401–11.
Pickering TG, Sos TA, Vaughan Jr ED, et al. Predictive value and changes of renin secretion in hypertensive patients with unilateral renovascular disease undergoing successful renal angioplasty. Am J Med. 1984;76:398–404.
Maxwell MH, Rudnick MR, Waks AU. New approaches to the diagnosis of renovascular hypertension. Adv Nephrol Necker Hosp. 1985;14:285–304.
Pickering TG, Sos TA, Vaughan Jr ED, Laragh JH. Differing patterns of renal vein renin secretion in patients with renovascular hypertension, and their role in predicting the response to angioplasty. Nephron. 1986;44 Suppl 1:8–11.
Vaughan Jr ED, Buhler FR, Laragh JH, Sealey JE, Baer L, Bard RH. Renovascular hypertension: renin measurements to indicate hypersecretion and contralateral suppression, estimate renal plasma flow, and score for surgical curability. Am J Med. 1973;55:402–14.
Strong CG, Hunt JC, Sheps SG, Tucker RM, Bernatz PE. Renal venous renin activity. Enhancement of sensitivity of lateralization by sodium depletion. Am J Cardiol. 1971;27:602–11.
Bartorelli AL, Marenzi G. Contrast-induced nephropathy. J Interv Cardiol. 2008;21:74–85.
Gill-Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. Predictors for clinical success at one year following renal artery stent placement. J Endovasc Ther. 2002;9:495–502.
Roubidoux MA, Dunnick NR, Klotman PE, et al. Renal vein renins: inability to predict response to revascularization in patients with hypertension. Radiology. 1991;178:819–22.
Marks LS, Maxwell MH. Renal vein renin: value and limitations in the prediction of operative results. Urol Clin North Am. 1975;2:311–25.
Rossi GP, Cesari M, Chiesura-Corona M, Miotto D, Semplicini A, Pessina AC. Renal vein renin measurements accurately identify renovascular hypertension caused by total occlusion of the renal artery. J Hypertens. 2002;20:975–84.
Kane GC, Textor SC, Schirger A, Garovic VD. Revisiting the role of nephrectomy for advanced renovascular disease. Am J Med. 2003;114:729–35.
Kane GC, Xu N, Mistrik E, Roubicek T, Stanson AW, Garovic VD. Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis. Nephrol Dial Transplant. 2010;25:813–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this chapter
Cite this chapter
Herrmann, S.M.S. (2014). Measurement of the Renin-Angiotensin System. In: Lerman, L., Textor, S. (eds) Renal Vascular Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2810-6_16
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2810-6_16
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2809-0
Online ISBN: 978-1-4471-2810-6
eBook Packages: MedicineMedicine (R0)