Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension

Main findings A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice. .

Estrogen and Enalapril attenuate the Development of Right Ventricular Hypertrophy induced by Monocrotaline in Ovariectomized Rats

The present study evaluated the importance of ovarian functions and the renin-angiotensin system in the progression of the right ventricular (RV) hypertrophy. Female Sprague-Dawley rats were bilaterally ovariectomized (Ovx) and injected with monocrotaline (MCT, 60 mg/kg, sc). Four weeks after MCT-treatment, only the male and Ovx female rats showed marked RV hypertrophy. The hypertrophied RV of the male-MCT and Ovx-MCT rats exhibited remarkably elevated renin mRNA levels. Gene expression levels of angiotensinogen, TGF-beta1, and endothelin-1 in the hypertrophied RV also increased, but to the less degree than did the renin mRNA. To investigate beneficial effects of estrogen or enalapril on progression of the pulmonary hypertension and RV hypertrophy, histological changes of the lung and heart were examined. Sham-MCT female rats showed histological changes indicating pulmonary hypertension without RV hypertrophy. In contrast, Ovx-MCT rats showed marked RV hypertrophy with pathological changes, denoting severe pulmonary and myocardial injuries. Estrogen-or enalapril-treated Ovx-MCT rats did not show RV hypertrophy, and showed remarkably ameliorated ultrastructural changes in the lung and RV. These results from this rat model suggest that both estrogen and inhibition of the renin-angiotensin system have protective functions against the development of the pulmonary hypertension and cardiac remodeling.

Actividad de renina en plasma en recién nacidos prematuros no enfermos / Plasma renin activity in health premature infants

En un estudio prospectivo, determinamos en una forma secuencial la actividad plasmática de renina (PRA) en los días 1, 3, 10, 17 y 24 de vida, en 16 recién nacidos prematuros no enfermos con una edad gestacional de 34.5+ - 0.9 semanas y un peso de 1,830 + - 268 g. Todos los pacientes incluidos en el estudio tenían que cumplir con los siguientes criterios: alimentación con leche materna, Apgar mayor de 7 a los 5 minutos y no padecer de ningún problema. La PRA alcanzó su pico máxima al 10o. día: 139.1 + - 82.9 ng/mLh. Los niveles séricos de sodio estuvieron en límites bajos desde el primer día de vida, y permanecieron así durante todo el tiempo de estudio. En base a nuestros resultados se puede especular que la actividad plasmática de renina en el recién nacido pretérmino persiste elevada durante el primer mes de vida, y parece estar relacionada con la hiponatremia fisiológica del prematuro que se acentúa más alrededor de la tercera y cuarta semana de vida