J Korean Soc Endocrinol.  2005 Apr;20(2):168-173.

A Case of Primary Reninism Manifested by Hypertension with Hypokalemia

• Choi HJ
• Hong ES
• Cho YM
• Park DJ
• Shin CS
• Park KS
• Kim SY
• Cho BY
• Lee HK

Abstract

Primary reninism is a rare cause of hypertension manifesting along with hypokalemia. A high level of plasma renin activity and a high level of serum aldosterone are the whole markers of primary reninism. Upon making the diagnosis of primary reninism, other more common causes of aldosteronism must be differentiated, such as renovascular hypertension and primary aldosteronism. Primary reninism is commonly caused by juxtaglomerular cell tumor, which is one of the curable causes of hypertension, and this can be successfully treated by conservative surgery. We report here on a case of primary reninism that was caused by juxtaglomerular cell tumor that developed in a 22-year-old female patient. She was recently diagnosed with hypertension and hypokalemia. She had markedly elevated plasma renin activity and an increased serum aldosterone concentration. Computed tomography revealed a mass located in the right kidney and selective renal vein sampling suggested that the mass was secreting an excess of renin. Right nephrectomy was done and her hypertension with hypokalemia was successfully treated. We report here a case of primary reninism that presented with juxtaglomerular cell tumor along with a review of the literature

MeSH Terms

Aldosterone
Diagnosis
Female
Humans
Hyperaldosteronism
Hypertension*
Hypertension, Renovascular
Hypokalemia*
Kidney
Nephrectomy
Plasma
Renal Veins
Renin*
Young Adult
Aldosterone
Renin

Figure

• 

  Fig. 1A Precontrast CT scan shows a round mass with heterogeneous attenuation in the lower pole of right kidney (arrows). Major part of the mass shows slightly high attenuation compared with renal parenchyma.

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  Fig. 1B On contrast-enhanced CT scan, this mass shows mild enhancement with a small, nonenhancing part in the anterior portion (arrow).

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  Fig. 2 On contrast-enhanced, fat-saturated T1-weighted sagittal MR images, this mass (arrows) shows low-signal intensity with renal parenchyma, suggesting hypovascularity.

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  Fig. 3 In microscopic examination, broad papillae covered by epithelioid cells was noted. And inside epitheloid cells. Islands of medium-sized round cells with pale cytoplasm and central nuclei was noted (H&E×200).

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  Fig. 4 PAS staining revealed intracytoplasmic PAS-positive pink granules (PAS×400).

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