Spermatic venous sampling in assisting the diagnosis of reninoma: One case report and literature review / 中华内分泌代谢杂志

To investigate the renal venous and spermatic venous sampling in assisting the diagnosis of reninoma. The case of reninoma was retrospectively reviewed together with the literature review of reninoma diagnosed with renal venous and spermatic venous sampling. A young patient with hypertension and headache was admitted to our hospital. Laboratory test showed high plasma renin concentration (>500 mIU/L), and enhanced computed tomography(CT) in the upper abdomen showed a mass in left inferior renal pole. The concentration of renin in the left spermatic vein was significantly higher than that in renal veins and branches, and peripheral vein, which was considered the left reninoma possibility. The left renal mass was resected surgically and pathologic exam revealed reninoma. The renin level and the blood pressure recoveried normal after operation.The literature reported that the positive rate of renal vein segmental blood collection for locating renin tumor was only 8.3%-64%. The possible reason was that reninoma usually located in the renal cortex, and the tumor blood might be collected by renal capsule vein instead of renal vein. In fact, the renal capsule vein intersects with the lateral division of the spermatic vein, but there have been no reports about the localization of reninoma by spermatic vein sampling. Since renin secreted by reninoma may go into the spermatic vein through renal capsule vein, it should be noted that spermatic venous blood should be collected simultaneously in renal vein sampling when locating reninoma.

Anesthetic management for percutaneous computed tomography-guided radiofrequency ablation of reninoma: a case report / 대한마취과학회지

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension.

A clinical analysis of reninoma-induced hypertensive crisis associated with reversible posterior encephalopathy syndrome / 中华内科杂志

Objective Reninoma is a rare benign tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia via hypersecretion of renin,while it is extremely rare that reninoma induced hypertensive crisis with reversible posterior encephalopathy syndrome (RPES).To improve the clinical understanding for this disease,we conducted a case-analysis.Methods To analyze the clinical and pathological data of a case of reninoma-induced hypertensive crisis with reversible posterior encephalopathy syndrome,who was admitted to Peking University First Hospital in November,2007 and follow-up.Results This was a 16-year old female patient,onset with suddenly spasm with loss of consciousness,while blood pressure stepped up to 210/140 mm Hg( 1 mm Hg =0.133 kPa),and the head magnetic resonance imaging (MRI) revealed “multiple long-T2 signal”,and hypopotassaemia(2.8-3.2 mmol/L),urine protein positive,ultrasoundcardiogram revealed left ventricular hypertrophy,laboratory study revealed hyperreninism (38.23ng · ml-1 · h-1,normal range 0.07-1.15 ng· ml-1 · h-1 ) and hyperaldosteronism(660.9 ng/L,normal range 60-174 ng/L),abdominal CT-Scan revealed a mass at right kidney,blood pressure achieved safety range and the head MRI was rechecked and revealed “the abnormal long-T2 signal disappeared”.The clinical diagnosis was reninoma induced hypertensive crisis with RPES.The tumor was resected and the pathologic diagnosis was reninoma.The patient remained normotensive in the postoperative period without any medication.Conclusions Reninoma represents a rare but surgically curable cause of hypertension,thus the clinical suspicion of it is very important in young patients.If the diagnosis is confirmed,positive treatment must be done immediately to improve the prognosis.The most common cause of RPES is hypertension,and the diagnosis depends on the distinctive head MRI.There is always a good prognosis with the decline of blood pressure rapidly.

Reninoma / 中国实用内科杂志

A reninoma is a renal juxtaglomerular cell apparatus tumor that produces excessive amounts of renin,resulting in secondary hyperaldosteronism,and associated hypertension and hypokalemia.It is a rare form of secondary hypertension and occurs mainly in young adult females.Common symptoms include headache,nocturia,polyuria,polydipsia,and fatigue.Imaging examination and selective renal vein sampling has been the traditional method of localizing the tumour.The diagnosis should be considered in all patients with hypertension and hypokalemia and no evidence of primary hyperaldosteronism and renal artery stenosis.Reninoma represents a surgically correctable cause of hypertension.