Hypertension and secondary hyperaldosteronism associated with a renin-secreting renal juxtaglomerular-cell tumour.

Abstract

<h2>Abstract</h2> A case of renin-secreting renal juxtaglomerular-cell tumour is described in an 8-year-old child. Severe hypertension associated with hypokalæmia was accompanied by raised plasma concentrations of renin, angiotensin II, and aldosterone in peripheral blood. The secondary hyperaldosteronism was shown not to be due to the malignant phase or to renal-artery stenosis. The tumour was lateralised by the demonstration of higher concentrations of renin and angiotensin II in left than in right renal venous plasma, and visualised on selective renal arteriography. The patient showed much greater elevation of blood-pressure and plasmaaldosterone than normal subjects infused with angiotensin to produce comparable plasma-angiotensin-II levels. Before operation, both head-up tilting and dietary sodium restriction caused a further striking increase of peripheral renin and angiotensin II. The hypertension and biochemical abnormalities were all relieved by removal of the affected kidney. The tumour had a very high content of renin. Extreme care is necessary in interpreting minor differences in renin level in renal veins if false-positive or falsenegative diagnoses are to be avoided.