腎素瘤合併術後持續高血壓與腎功能異常- 一個罕見的病例報告
李采霓、黃國皓
國立台灣大學附設醫院 泌尿部
Persistent hypertension and impaired renal function despite successful resection of a reninoma – a rare case report
Tsae-Ni, Lee、Kuo-How Huang
Department of Urology, National Taiwan University Hospital
Abstract
Introduction:
A reninoma, also known as a juxtaglomerular cell tumor (JGCT), is a rare renal tumor that secretes renin, further causing secondary hypertension. Surgical resection of the tumor is the optimal treatment, and previous literature has shown improvement of the patient’s blood pressure after tumor resection. The first reported JGCT resected through robotic surgery was in 2020 (1), by urologists in Chung-Ang University College of Medicine, Seoul, Korea. Here, we present a case of reninoma that was resected by a robot-assisted partial nephrectomy.
Case presentation:
The initial presentation of reninoma in our case was hypertension, which was difficult to control. Her condition gradually worsened, and heart failure developed. In addition, renal failure, which is implied to be due to cardiorenal syndrome, also occurred. And despite our case’s reninoma was successfully removed via surgery, and that the postoperative lab data showed normalization of her serum potassium and sodium levels, impaired renal function was still noted and she still needed hemodialysis. In addition, the blood pressure of the cases of reninoma patients reported in previous studies all normalized after a surgical resection of the reninoma, however, in our case, despite the dosage and types of antihypertensive medications did decrease after the reninoma was resected, our patient still needed an angiotensin II receptor blocker, a beta-blocker, and a calcium channel blocker to control her blood pressure.
As far as we know, this is the first case whose hypertension did not cure after the reninoma was resected. Furthermore, no case has been reported to suffer from prolonged renal damage, leading to hemodialysis.
Conclusion:
The cause of a secondary hypertension can be tricky to diagnose, for many various etiologies, such as a pheochromocytoma, or despite rare, a reninoma, may present with an elevated blood pressure. Urologists must always be alert of a different diagnosis, especially when encountering refractory hypertension, hypokalemia, and even acute decompensated heart failure. In our case, we successfully removed a reninoma via robot-assisted partial nephrectomy. Previous published cases showed a normalization of the patient’s plasma renin, serum potassium levels, and blood pressure without the usage of any antihypertensive medications after the renin-secreting tumor was resected. However, despite a decrease of the dosage and numbers of antihypertensive medications taken, the patient still needed 3 types of antihypertensive medications to control her blood pressure after the surgery. In addition, minimal improvement of her renal function was noted despite the tumor being resected. Could delayed treatment of a renin-secreting tumor possibly lead to permanent damage in the patient’s kidney and even cardiac function? Despite this, a robot-assisted partial nephrectomy was shown in our case to be a successful approach for a resection of a renin-secreting tumor.