Post-transplant hypertension. Normoreninemic severe hypertension treated by bilateral nephrectomies.

In a nineteen-year-old male in whom severe and protracted hypertension developed after a successful renal transplantation, the removal of the diseased kidneys resulted in restoration of normal blood pressure. Prenephrectomy blood samples obtained from the venous drainage of all three renal veins demonstrated no evidence for excessive renin secretion, nor was a significant difference in renin activity found between any two kidneys. It is postulated that the patient may be a clinical variant of the experimental form of renal hypertension with normoreninemia. Alternatively, the remnant kidneys may be implicated to produce a nonrenin pressor substance.

High-output congestive failure from femoral arteriovenous shunts for vascular access.

Femoral arteriovenous bovine shunts (FAVBS) represent an accepted method of vascular access for patients requiring chronic hemodialysis. The authors present 4 patients who required corrective surgery for high-putput congestive heart failure (HOCHF) secondary to high flow rates through the shunt. In order to avoid this serious complication, intraoperative graft flow rates should not exceed 900 cc/min. HOCHF secondary to FAVBS may be refractory to conservative therapy and require either banding of the shunt or its removal.