Renovascular Hypertension

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Abstract
The renal lesions capable of producing hypertension have been reviewed. Three cases were studied which illustrate 3 uncommon causes of hypertension. The first case illustrates how intrinsic neoplastic renal disease may produce hypertension. In the second case, a congenital band of a fibromuscular nature from the psoas minor muscle caused constriction of the renal artery and resulted in hypertension. In the third case, a neoplasm surrounded and obliterated the renal circulation to one kidney. All 3 cases illustrate how extrinsic pressure may result from various causes and result in hypertension. The causal relationship between renal neoplasms and hypertension has now become definitely established. This is one of the less common causes of hypertension, but is now clearly delineated by 4 possible mechanisms. A neoplasm may produce extrinsic pressure on the renal artery. Arteriovenous shunting of blood within a renal tumor can lower renal vascular resistance. A neoplasm can surround and obliterate the renal circulation to one kidney. An intrarenal neoplasm may cause pressure on adjacent normal renal parenchyma producing localized ischemia. Obstruction to venous drainage by tumor (extrinsic or intrinsic) has also been postulated, although the mechanism is unclear.