[Renal artery obstruction: from experimental models to logical approach to diagnosis and treatment]

Abstract

Renovascular hypertension is a syndrome for which, historically, the description of the pathophysiological model in animals preceded the clinical description in human patients. These models allow to understand the local paracrine and systemic endocrine role of the renin-angiotensin system. Whatever the method used to induce renovascular hypertension, the model goes through an initial stage of renin-angiotensin activation, which is followed sooner or later by retention of salt and water. The logical approach to the diagnosis and treatment of renovascular hypertension in man proceeds from this experimental pathophysiological description. The diagnosis establishes a relationship between the stenosis of the renal artery, the systemic arterial hypertension associated with its consequences on the target organs, particularly the kidney downstream to the stenosis (ischaemia) and the contralateral kidney exposed to hypertension, and the high levels of circulating renin and angiotensin (nephro-angiosclerosis). The diagnosis involves a systemic and separate approach to the endocrine and excretory functions of the kidney under basal conditions and after acute blockade of the renin-angiotensin system. Therapeutic indications also proceed from similar logical pathophysiological approaches.