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保留肾单位手术治疗肾素瘤:一种导致继发性高血压的罕见肾素分泌肿瘤。

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

作者信息

Torricelli Fabio Cesar Miranda, Marchini Giovanni Scala, Colombo Jose Roberto, Coelho Rafael Ferreira, Nahas Willian Carlos, Srougi Miguel

机构信息

Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Department of Urology, Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil.

出版信息

Int Braz J Urol. 2015 Jan-Feb;41(1):172-6. doi: 10.1590/S1677-5538.IBJU.2015.01.23.

Abstract

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 After surgery, she recovered uneventfully and all medications were withdrawn.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.

摘要

一名25岁的高血压女性患者被转诊至我院。初步检查显示右肾下极有一个2.8厘米的皮质肿瘤。她接受了腹腔镜部分肾切除术,未出现并发症。组织病理学检查显示为一种罕见的肾小球旁细胞瘤,即肾瘤。术后,她恢复顺利,所有药物均已停用。病例假设:继发性动脉高血压是泌尿外科医生和肾内科医生非常关注的问题。肾血管性高血压、原发性醛固酮增多症和嗜铬细胞瘤是不能被忽视且应排除的潜在诊断。虽然罕见,但慢性肾盂肾炎和肾肿瘤,如产生肾素的肿瘤、肾母细胞瘤、肾上腺样瘤和肾细胞癌也可能诱发高血压,应列入临床医生的诊断清单。未来的潜在意义:大约5%的高血压患者有特定病因,医学检查通常可以识别出这类患者。此外,这些患者大多可通过微创技术成功治疗并治愈。这个有趣的病例可能会拓宽医生的知识面,并有助于在未来的医疗实践中提供更好的诊断护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/184d/4752071/1422d902386f/1677-5538-ibju-41-1-0172-gf01.jpg

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