The Association of Unilateral Kidney Disease with Hypertension

Abstract

That essential hypertension may be associated with and produced by unilateral renal disease seems now to be an established fact, both experimentally and clinically. Equally certain is the fact that not all cases of essential hypertension are due to unilateral kidney disease and conversely that all patients with unilateral renal disease do not have hypertension. We therefore find ourselves in that confusing stage of clinical investigation where we are attempting to determine which case of hypertension can be attributed to unilateral renal disease.

It has long been known that hypertension may be associated with obstructive lesions of the urinary tract or any other disease which results in severe damage and destruction of renal parenchyma, such as in polycystic kidneys. The conception, however, that unilateral kidney disease might produce hypertension is very recent and a large share of credit for stimulating clinical interest in this phase of hypertension must go to the experimental work of Goldblatt¹. Working with dogs and monkeys, he showed that when the renal artery on one side was constricted with an especially devised clamp, hypertension resulted which usually tended to return to normal after a period of time, although in some instances of unilateral constriction of the renal artery hypertension has been reported to exist for as long as two years. Removal of this ischemic kidney resulted in prompt return of the blood pressure to normal. Goldblatt also showed that constriction of both renal arteries resulted in a sustained elevation of both the systolic and diastolic pressures. . .