Malignant Hypertension

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Abstract
The increased appreciation of the role of renin in the pathogenesis of hypertension and the availability of chronic maintenance hemodialysis, during the past decade, laid the groundwork for a new and totally different approach to the treatment of patients with end-stage renal disease and hypertension. As a result, from 1963 to 1968, several reports appeared in the literature regarding the effectiveness of bilateral nephrectomy in the control of severe hypertension in these patients.1-4 In 1969, Vertes and associates5 presented evidence on the basis of which hypertensive patients on chronic dialysis could be divided into two distinct groups. The first, with normal or slightly elevated renin levels, would become normotensive without antihypertensive therapy as long as they received ultrafiltration sufficient to maintain their dry weight. The second, with very high levels of plasma renin activity, would remain hypertensive despite the attainment of dry weight and would manifest a poor

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