Clinical evaluation of hypertensive patients: Indications for and utilization of the isotope renogram, separated renal function study and aorticorenal arteriogram

Four cases of hypertension secondary to lesions of the renal arteries are presented with comments on the history, results of physical and laboratory examinations and surgical findings. Points emphasized are as follows: 1. 1. Hypertension of renal or renal arterial origin should be suspected in the presence of: (A) acute hypertension in young patients with angiospastic ocular changes; (B) rapidly progressive symptomatic hypertension of recent onset; (C) abrupt acceleration of chronic essential hypertension; (D) a history suggestive of a recent renal vascular accident; (E) a continuous bruit over the superolateral area of the abdomen and (F) a disparity in the size and function of the kidneys on excretory urography. 2. 2. In our experience the isotope renogram has served as an excellent screening procedure for the evaluation of renal function in hypertensive patients. 3. 3. Renal arteriography is a highly desirable procedure which aids in the more complete evaluation of hypertensive patients in whom abnormalities suggestive of renal arterial disease are found on physical or urographic examination or in the isotope renograms. This is especially true when surgical intervention is planned. The vagaries of translumbar aorticorenal arteriography are legion. Retrograde aortographic technics for renal arteriography are technically more satisfactory in our experience. 4. 4. Evaluation of function of each kidney alone may on occasions prove not only of diagnostic help, but more importantly, it may provide evidence of the adequacy of function of the individual kidneys, and thus may prove decisive regarding the feasibility of surgical intervention.