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January 1964

Occult Primary Renal Disease in the Hypertensive Patient

Author Affiliations


Resident in Medicine, Hospital of the University of Pennsylvania (Dr. Roland); Associate Professor of Medicine, Chief, Allergy and Immunology Section, Hospital of the University of Pennsylvania, John and Mary R. Markle Scholar in Medicine, 1958-1963 (Dr. Hildreth); Assistant Clinical Professor of Medicine, Chief, Hypertension Section, Hospital of the University of Pennsylvania (Dr. Sellers).; From the Department of Medicine, Hospital of the University of Pennsylvania.

Arch Intern Med. 1964;113(1):101-110. doi:10.1001/archinte.1964.00280070103017

Introduction  Since Goldblatt's original description of the production of hypertension by partial constriction of the renal artery of dogs in 1934,1 there has been increasing interest in the relationship of the kidney to human hypertension. Clinical interest was originally confined largely to parenchymal renal disease, especially unilateral pyelonephritis, hydronephrosis, and the atrophic kidney. A large number of hypertensive patients with unilateral parenchymal renal disease were subjected to nephrectomy. Enthusiasm for this procedure, though initially high, was dampened considerably by Homer Smith's reviews of the results in 1943 2 and again in 1956.3 In the latter report, only 26% of 575 unilateral nephrectomies had resulted in cure of hypertension.During the past five years, due largely to advances in vascular reconstructive surgery, increasing attention has been directed towards renovascular disease. Here, the results of surgery have been considerably better. In carefully selected patients there has been a 40% to

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