Hypertension Due to a Renin-Secreting Tumour Localised by Segmental Renal Vein Sampling

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Abstract
An 18 yr old female was hypertensive on routine medical examination. Further investigation disclosed persistent hypokalemia and elevated plasma renin activity in peripheral venous blood. Segmental renal vein sampling with assay of blood samples located the source of excess renin secretion in the lower midzone of the left kidney. This localization was not confirmed by angiography or palpation of the exposed kidney before nephrectomy but macroscopic examination of the freshly sectioned kidney revealed a small tumor in the region suggested by renal vein sampling. The tumor had the morphologic pattern of a hemangiopericytoma with abundant ultrastructural specific granules and high renin activity by tissue assay. Plasma renin activity fell precipitously after nephrectomy and remained low for the 1st wk. Although the immediate postoperative blood pressure fell to normal, hypertension recurred temporarily and was associated with elevated plasma aldosterone, producing a syndrome similar to primary aldosteronism. All variables returned to normal without specific therapy and hypertension has not recurred.