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By A. M. Davison (Auth.)

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Extra resources for A Synopsis of Renal Diseases

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1. Infusion of 10 m g / k g / m i n for 3 0 min. 2. V. injection of 10 m g over 2 min. A positive test is indicated b y a r e d u c t i o n in systolic pressure of at least 20 m m H g a n d a r e d u c t i o n in diastolic pressure of 10 mgHg. T h e e x a c t place of this test in t h e investigation of t h e h y p e r t e n s i v e p a t i e n t is n o t established and it is n o t invariably positive in cases of r e n i n - i n d u c e d h y p e r t e n s i o n . Clearly it requires detailed evaluation.

T h e prognosis in malignant h y p e r t e n s i o n is p o o r n o t only because of t h e underlying cause of t h e h y p e r t e n s i o n b u t because of t h e c o n s e q u e n c e s o n b l o o d vessels. Most p a t i e n t s die from either renal or cardiac failure. T h e r e is also an increased incidence of cerebral c o m p l i c a t i o n s a n d t h e rarer o c c u r r e n c e of retinal a t r o p h y . PATHOGENESIS OF RENAL HYPERTENSION T h e kidney m a y be involved in t h e p r o d u c t i o n and m a i n t e n a n c e of hyper­ tension.

2. Surgery, This should only be e m p l o y e d in p a t i e n t s w h o c a n n o t b e controlled b y medical means. In a t h e r o m a it is possible t o p e r f o r m vein bypass, t h r o m b o e n d a r t e r e c t o m y , p a t c h angioplasty or t o insert a D a c r o n prosthesis. In fibromuscular hyperplasia t h e k i d n e y can b e 48 A SYNOPSIS O F R E N A L D I S E A S E S removed, cooled a n d t h e n b e n c h surgery p e r f o r m e d o n t h e fibro­ muscular b a n d . T h e k i d n e y is t h e n i m p l a n t e d in t h e pelvis.

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