The renin-angiotensin system was studied in patients with bilateral renal-artery stenosis, renal-artery stenosis to a transplanted kidney, unilateral renal-artery stenosis with a severely diseased contralateral kidney, and coarctation of the aorta. All these patients had normal or low plasma renin activity while on an unrestricted salt intake. Volume contraction with a low salt diet and furosemide administration caused a marked increase in renin activity (as high as 70 ng/ml/hr) but resulted in no change in blood pressure. We postulate an interrelationship between renin and volume in the pathogenesis of hypertension such that underperfusion of the total renal mass results in hyperreninemia and hypertension; underperfusion also results in salt retention and volume expansion that then inhibits renin release but perpetuates the hypertension on a volume rather than a pressor basis.
Kurtzman NA, Pillay VKG, Rogers PW, Nash D. Renal Vascular Hypertension and Low Plasma Renin Activity: Interrelationship of Volume and Renin in the Pathogenesis of Hypertension. Arch Intern Med. 1974;133(2):195–199. doi:10.1001/archinte.1974.00320140033003
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