Immunologic Considerations in Renovascular Hypertension

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Abstract
Certain diseases, such as glomerulonephritis, polyarteritis nodosa, scleroderma and serum sickness, were previously linked with autoimmune pathogenesis. Recently, a host of additional diseases, thought to have some genetic predisposition but with obscure etiology, were suspected of being autoimmune in nature. Rheumatoid arthritis, diabetes, myasthenia gravis and thyroiditis are diseases of widely divergent organ systems, yet may have common pathways of pathology via immune complexing mechanisms. This study indicates that renal artery stenosis (occurring primarily in association with the middle aortic syndrome or after renal transplantation) is of immune etiology. Although the specific antigenic agent is still to be defined, medium and large vessels are apparently subject to autoimmune vasculitis in many aspects similar to the autoimmune affections of small vessels. Several [human] cases are presented. Some of these suggest an immune reaction by their natural history but without evidence of immunochemical reactants in the involved vessels, presumably because active disease was arrested at the time of study. In other cases immunofluorescent preparations demonstrate reactants in the walls of the vessels to document the hypothesis more convincingly.