CLINICAL AND PATHOLOGICAL STUDY ON THE RENAL ARTERY STENOSIS

In 145 autopsy cases, kidneys, extrarenal arteries and abdominal aorta were removed en bloc at the time of necropsy, and aortorenal angiography was undertaken for the study of renal artery lesions. Pathological changes of the kidney and renal artery were also observed. Pathological studies of kidney, extrarenal artery and aorta were also performed in 65 hypertensives without postmortem angiographies to observe the significance of renal artery stenosis in the genesis of hypertension. Results obtained were as follows:1. Severe renal artery stenosis was found in 2 of 70 normotensives in age from 17 to 76 years and in 2 of 28 normotensives from 50 to 69 years old.2. Stenosis of the renal artery was found in 11 of 42 hypertensives from 49 to 86 years and in 5 of 19 hypertensives from 50 to 69 years old.3. Renal artery stenosis was found in 11 of 56 hypertensives whose angiography was not undertaken at the time of necropsy.4. In all instances of renal artery stenosis, arteriosclerotic lesion was found to produce lumen narrowing.5. Renal accessory artery arising separately from the abdominal aorta was found in 23 of 53 hypertensives and in 29 of 84 normotensives.6. Marked narrowing of the accessory artery was found in one of the hypertensive cases.7. Intimal involvement of the aorta was severe in the hypertensives with renal artery stenosis. Renal artery stenosis was found more frequently in hypertensives whose surface involvement of the aorta was more than 70 per cent.8. Average length of the right kidneys was 11. 1cm and that of the left kidneys was 11.4cm in 68 normotenslve cases.9. Pyelonephritis was found in 7 of 83 normotensives and in 8 of 53 hypertensives whose postmortem angiographies were undertaken. Moreover it was found in 8 of 65 hypertensive cases who were not examined radiologically.10. Arteriolar nephrosclerosis was found in 2 (3 per cent) of 70 normotensive cases and in 41 of 42 hypertensive cases. One hypertensive case without arteriolar sclerosis showed stenosis of the unilateral main renal artery.11. Arteriolar nephrosclerosis was noted in all of 56 hypertensive cases without postmortem angiography.12. Arcuate and subarcuate arteries in hypertensive cases were slightly dilated, and interlobular arteries were kinked and branched in an obtuse angle.