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Invited Commentary
November 2014

The Kidney ConnectionHoly Grail or Wild Goose Chase?

Author Affiliations
  • 1Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
  • 2University of Missouri–Kansas City, Kansas City
JAMA Intern Med. 2014;174(11):1851-1852. doi:10.1001/jamainternmed.2014.3139

The pathophysiologic mechanisms of renovascular hypertension are well described: Hemodynamically significant renal artery stenosis results in reduced renal perfusion pressure, which in turn leads to activation of the renin-angiotensin system and increased levels of angiotensin II, resulting in systemic vasoconstriction, aldosterone release, sodium retention, and expansion of extracellular fluid volume and blood volume. Logically, reversal of the restriction in flow and establishment of normal renal perfusion pressure should reverse the process and decrease blood pressure. Nevertheless, the clinical benefits of renal artery revascularization in the setting of refractory hypertension have been variable, and largely disappointing.

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