Laparoscopic nephro-sparing surgery of juxtaglomerular cell tumor in a child

Abstract

To report a case of juxtaglomerular cell tumour of the kidney (reninoma) in a child treated with laparoscopic nephron-sparing surgery. A 14-year-old girl was incidentally found to have hypertension (180/114mmHg) at the time of adenotonsillectomy. Pre-operative investigations revealed a plasma renin level of 225.9ng/dl (4.4-46), normal aldosterone, cortisol and urinary catecholamine. Abdominal ultrasound detected a 1.9×1.5-cm hypoechoic lesion in the right kidney lower pole; CT scan confirmed the presence of a 1.5-cm, circumscribed, solid, hypoenhancing cortical lesion in the right lower pole. Laparoscopic nephron-sparing surgery was accomplished by clamping the renal artery for 30min; after excision, the tumour bed was closed using barbed V-loc sutures. The procedure was completed laparoscopically in 150min with no peri-operative complications. The patient was discharged home on day 4 postoperatively. Histology confirmed the diagnosis of a juxtaglomerular cell tumour that was completely excised. The J-J stent was removed 1 month later. At follow-up, the patient's blood pressure was normalized and medications were stopped. A DMSA scan confirmed 36% residual right kidney function. Laparoscopic nephron-sparing surgery should be considered in children with juxtaglomerular tumours. This technique allows prompt recovery with preservation of significant renal function.