Acquired Renal Artery Stenosis and a Positive Renal-Vein Renin Ratio

Excerpt

To the editor: The measurement of bilateral renal-vein plasma renin activity has been used to select hypertensive patients with anatomic renal artery stenosis for surgical therapy. Ratios of renin in the two renal veins of 1.5:1 or greater have been considered positive; however, persistent hypertension (diastolic pressure of 90 mm Hg or greater) has been reported in 14% to 50% of such patients after corrective surgery (1-5). Persistent hypertension may be owing to either failure to restore adequate flow to the ischemic kidney or to diagnostic error. The latter is not unexpected. First, the finding of renal-vein plasma renin activity