Trypsin Injection into Renal Arteries

For many years, it has been accepted that derangement of kidney function is intimately related to hypertension. Fishberg (1), de Wesselow (2) and Volhard (3) have pointed out that, with the exception of amyloid degeneration of the kidneys, severe kidney derangement is consistently accompanied by hypertension. The frequent absence of hypertension in amyloid involvement of the kidney has been supposed to be due to the cachexia accompanying this disease. However, the direct proof of the relationship of deranged kidney function to hypertension is still lacking in the patient. Carri~re a al. (4), Kylin (5), Brems (6),Loewenstein (7),Bohn (8), Hiilse and Strauss (9) and Major (10) have reported the presence of abnormalities in the chemical composition of the blood in patients suffering with hypertension. These results were not substantiated by Page (11), Elliott and Nuzum (12), Weinstein and Weiss (13), Leiter (14), de Wesselow and Griffiths (15), Aitken and Wilson (16), Jackson et al. (17) and Andes a al. (18), who have reported that the blood of patients suffering with hypertension is apparently normal except when marked kidney excretory insufficiency is present. Nor could these workers establish the presence of abnormal pressor substances. The inability to demonstrate conclusively any qualitative or quantitative change in the blood of hypertensive patients who have kidney function essentially normal does not disprove the possibility that hypertension is related to derangement in the kidney, but it does tend to deter the facile assumption that this relationship has been demonstrated clinically. Experimental studies upon laboratory animals also fail to give any dear indication of a relationship between kidney function and hypertension. Pgssler and Heineke (19), Chanutin and Ferris (20), and Wood and Ethridge (21) have reported hypertension following the surgical removal of such large amounts of norreal kidney tissue as to cause renal excretory insufficiency. However, Anderson (22) found excretory insufficiency alone, without hypertension, after a similar procedure. Cash (23) on the other hand observed the occurrence of hypertension following partial nephrectomy and renal artery ligation leading to kidney necrosis and renal excretory insufficiency; Arnott and Kellar (24) observed hypertension