STUDIES ON RENAL HYPERTENSION

REPORT I. CLINICAL OBSERVATION ON THE RELATION BETWEEN URINARY DISEASES AND HYPERTENSION

Abstract

Clinical observation on the relation between urological diseases and blood pressure were made of 898 in-patients in the Urological Department of Kumamoto University Hospital from 1954 to 1960, and the following results were obtained.
1) Hypertension was seen in 14.5% of the patients with urological diseases. The frequency of hypertension was significantly high at the age of 39 or less, but was not so in the older age group as compared with normal persons.
2) Hypertension was seen in 7.5% of unilateral renal diseases, 19.8% of bilateral renal diseases and 22.2% of lower urinary diseases.
In the majority of hypertensive cases with bilateral urinary diseases, severe disturbance of renal function due to urinary tract obstruction was noticed and blood pressure was descended by nephroor ureterostomy.
4) Of unilateral urinary diseases, the frequency of hypertension was high in pyelonephritis (37.5%) and renal tumor (31.6%) and less than 10% in other diseases such as urolithiasis, urinary tuberculosis, nephroptosis, hydronephrosis, chyluria and renal hematuria. Generally, hypertension was more frequent in cases with severely involved renal parenchyma. Some cases of renal tuberculosis and pyelonephritic contracted kidney recovered from hypertension by removing the involved kidney.
5) Hypertension was seen in 15.2% of bilateral urolithiasis and 4.8% of unilateral one. Hypertension was more frequent in the cases complicated with urinary infection or hydronephrosis than in non-complicated cases and more frequent in patients with larger or multiple stones than those with smaller ones.
6) Of the diseases of the lower urinary tract, hypertension was the most frequent in chronic obstructive diseases such as prostatic hypertrophy (35.0%). Some relation was observed between blood pressure and the volume of residual urine.
7) Hypertension in chronic obstructive diseases was divided into two types: renal hypertension due to urinary retention and extrarenal hypertension which was occasionally complicated. In the former type, hypertension was releaved by indwelling catheterization.
8) These results show that hypertension due to urinary diseases and releaved by the treatment for them is clearly present although it is not frequent. The common findings in this type of hypertension are urinary infection, atrophy on the renal parenchyma, circulatory disturbances of the renal arteries and obstruction of the urinary tract, but these are not always essential to the development of renal hypertension.