Reninoma: The importance of renal vein renin Ratios for lateralisation and diagnosis

Wolley, Martin, Gordon, Richard D. and Stowasser, Michael (2014) Reninoma: The importance of renal vein renin Ratios for lateralisation and diagnosis. American Journal of Nephrology, 39 1: 16-19. doi:10.1159/000357410

Author Wolley, Martin
Gordon, Richard D.
Stowasser, Michael
Title Reninoma: The importance of renal vein renin Ratios for lateralisation and diagnosis
Journal name American Journal of Nephrology   Check publisher's open access policy
ISSN 0250-8095
Publication date 2014-02
Year available 2013
Sub-type Article (original research)
DOI 10.1159/000357410
Open Access Status DOI
Volume 39
Issue 1
Start page 16
End page 19
Total pages 4
Place of publication Basel, Switzerland
Publisher S. Karger AG
Collection year 2014
Language eng
Formatted abstract
Reninomas are rare juxtaglomerular tumours which can cause severe hypertension and hypokalaemia. Diagnosis can be problematic and these tumours can be difficult to locate on imaging. In this report we aim to demonstrate the value of carefully performed renal vein renin ratios (RVRRs) to assist in locating these tumours.

We report on 3 patients diagnosed with reninoma in our unit. The patients were all female, young (17, 16 and 30 years), severely hypertensive and hypokalaemic (2.5, 2.5 and 3.1 mmol/l). Plasma renin activity (PRA) was elevated (31.9, 274 and 175 ng/ml/h), and aldosterone was high-normal (19.9 ng/dl) or elevated (207 and 109.3 ng/dl). Renal artery stenosis was excluded by renal artery Doppler, DTPA scan and angiography. Renal CT detected the lesion in 2 patients, with one lesion visible on pre- and post-contrast CT and the other on post-contrast CT only. RVRRs were performed several weeks after withdrawing interfering medications, maintaining a <40 mmol/day low-sodium diet and maintaining recumbency overnight the night before and during the procedure. Ratios before and after captopril or enalaprilat administration were obtained and lateralised the tumours in all 3 cases (dominant/non-dominant ratios of 2.3, 4.3 and 3.8). All of the patients underwent nephrectomy yielding a typical juxtaglomerular tumour and resulting in cure of hypertension and hypokalaemia.

Reninoma should be suspected in young hypertensives (especially females) with significant hypokalaemia and high PRA or direct renin concentration after renovascular hypertension has been excluded. CT imaging and carefully performed RVRRs provide the highest likelihood of locating these tumours.
Keyword Renal vein renin ratio
Secondary hypertension
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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