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Malignant hypertension due to renal artery stenosis. Greater renin release from the nonstenotic kidney.

In a patient with malignant hypertension, an excretory urogram revealed a nonfunctioning left kidney while aortography demonstrated severe stenosis of the right renal artery. Renal venous renin activity was markedly elevated on the nonstenotic side. Right aortorenal bypass graft together with left nephrectomy resulted in cure of the patient's hypertension. Microscopic study of the resected kidney revealed a severe necrotizing arteriolopathy typical of malignant hypertension. This case is analogous to Floyer's findings in the rat. The intrarenal arteriolopathy of malignant hypertension is responsible for the paradoxically elevated renin activity from the nonstenotic kidney.