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Choi, Hong, Cho, Park, Shin, Park, Kim, Cho, and Lee: A Case of Primary Reninism Manifested by Hypertension with Hypokalemia
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2005; 20(2): 168-173.

Published online: 20 April 2005

DOI: https://doi.org/10.3803/jkes.2005.20.2.168

A Case of Primary Reninism Manifested by Hypertension with Hypokalemia

Hyung Jin Choi, Eui Sil Hong, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee

Department of Internal medicine, Seoul National University College of Medicine, Korea.

Received 27 December 2004       Accepted 3 February 2005

Copyright © 2005 Korean Endocrine Society

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.

Keywords: Primary reninism, Juxtaglomerular cell tumor, Renin, Aldosterone, Hypertension, Hypokalemia

Figures and Tables

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).
jkse-20-168-g004
Fig. 4
PAS staining revealed intracytoplasmic PAS-positive pink granules (PAS×400).
jkse-20-168-g005

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