Antibody deficiency with normal immunoglobulins

Abstract

Total nephrectomy was performed in our patient even though only an upper pole tumor was identified because the lower pole renin values were markedly elevated and it was uncertain that only a single tumor existed. In a similar patient? segmental renal vein-renin data revealed increased secretion from the middle pole area, but at surgery only an upper pole tumor could be identified. Following nephrectomy, the upper pole lesion was diagnosed as a cortical mesenchymal nodule, whereas a renin-secreting tumor was found in the region of the middle pole corresponding to the area of increased renin secretion. In our patient, examination of renal tissue from the lower pole as well as from the remainder of the nontumorous renal parenchyma revealed severe arteriolar changes, but no tumor. The elevated renin activity from the left lower pole renal vein suggests that these arteriolar lesions resulted in compromised distal perfusion. In contrast, the patient who underwent successful tumorectomy '~ had maximal elevation of renin activity from the tumorous segment of the involved kidney, and the adjacent parenchyma showed only mild intimal proliferation of the small arteries. Similarly, vessels in the nontumorous renal parenchyma of other reported patients have either been normal or have had less severe changes than in our patient.' .... Consequently, in our patient tumorectomy alone might not have been successful. These findings suggest that identification of patients who may benefit from local excision of renin-secreting tumors may be improved by segmental renal vein-renin determinations. When increased segmental renin secretion coincides with the anatomic localization of the tumor, the decision to perform a subtotal nephrectomy would be