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March 1993

Unilateral Renal Artery Stenosis Seen Initially as Severe and Symptomatic HypokalemiaPathophysiologic Assessment and Effects of Surgical Revascularization

Author Affiliations

From the Section of Vascular Surgery, Department of Surgery (Drs Ruby and Burch), and Section of Hypertension and Vascular Diseases, Department of Medicine (Dr White), University of Connecticut School of Medicine, Farmington.

Arch Surg. 1993;128(3):346-348. doi:10.1001/archsurg.1993.01420150106019

• Hypokalemia is an uncommon presentation of renovascular hypertension. Although renal artery stenosis has been associated with hypokalemia secondary to hyperreninemic hyperaldosteronism, few reports have actually evaluated the pathophysiologic changes in such a patient with renovascular hypertension. We studied a patient before and after surgical revascularization who presented with severe hypertension and marked, symptomatic hypokalemia. Before surgery, the patient had excessive urinary potassium secretion, markedly increased secretion of renin after captopril stimulation, and mild secondary hyperaldosteronism. Postoperatively, the patient's blood pressure decreased moderately and the serum and urinary potassium values normalized. After revascularization, plasma renin activity both before and after captopril stimulation and serum aldosterone levels decreased markedly. These findings demonstrate that renovascular hypertension may rarely present with symptomatic hypokalemia secondary to excessive aldosterone secretion. Improvement in the renal ischemic state is accompanied by rapid correction of the metabolic disturbances associated with hyperreninemic hyperaldosteronism.

(Arch Surg. 1993;128:346-348)

Working Group on Renovascular Hypertension.  Detection, evaluation, and treatment of renovascular hypertension: Final report . Arch Intern Med . 1987;147:820-829.Article
Capelli JP, Housel EL, Zimskind PD, et al.  Renovascular hypertension: prospective diagnostic yield in a random access population . Urology . 1973; 2:324-333.Article
Vaughn ED Jr, Case DB, Pickering TG, et al.  Clinical evaluation of renovascular hypertension and therapeutic decisions . Urol Clin North Am . 1984;11:393-407.
Maxwell MH.  Cooperative study of renovascular hypertension: current status . Kidney Int . 1975;8:S153-S160.
Novick AC, Banowsky LH, Stewart BH, Straffon RA.  Splenorenal bypass in the treatment of stenosis of the renal artery . Surg Gynecol Obstet . 1977; 141:891-896.
Muller FB, Sealey JE, Case DB, et al.  The captopril test for identifying disease in hypertensive patients . Am J Med . 1986;80:633-644.Article
Biglieri EG, Irony I, Kater CE.  Adrenocortical forms of human hypertension . In: Laragh H, Brenner B, eds. Hypertension . New York, NY: Raven Press; 1990:1609-1623.
McAreavey D, Brown JJ, Cumming AMM, et al.  Inverse relation of exchangeable sodium and blood pressure in hypertensive patients with renal artery stenosis . J Hypertens . 1983;1:297-302.Article
Bunchman TE, Sinaiko AR.  Renovascular hypertension presenting with hypokalemic metabolic alkalosis . Pediatr Nephrol . 1990;4:169-170.Article