A case of hyperreninemic hypertension after extracorporeal shock-wave lithotripsy.
A 53-year-old male was found to have hypertension caused by the significant secretion of renin from an atrophic left kidney. He had undergone extracorporeal shock-wave lithotripsy (ESWL) for left renal lithiasis 11 years previously. A renal dynamic study with 99mTc-diethylenetriaminepentaacetic acid (DTPA) indicated that the rate of renal excretion and uptake was decreased in the left kidney and normal in the right kidney. Renal angiography demonstrated a normal right renal artery and a small but nonstenotic left renal artery. The ratio of PRA in the left renal vein to that in the right renal vein was 1.7. Blood pressure could be lowered to the range of 140-150/80-90 mmHg with imidapril, an ACE inhibitor. ESWL may cause hypertension via the well-known Page kidney effect. In this case, the kidney, atrophic probably due to ESWL, released a significant amount of renin.
Sasaguri
M
M
Department of Internal Medicine, Fukuoka University School of Medicine, Japan.
Noda
K
K
Matsumoto
T
T
Shirai
K
K
Tsuji
E
E
Tsuji
Y
Y
Arakawa
K
K
D015901:Angiography, Digital Subtraction; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001027:Aortography; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007093:Imidazoles / Q000627:therapeutic use; D048289:Imidazolidines; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging; D012082:Renal Veins; D012083:Renin / Q000097:blood*; D016284:Technetium Tc 99m Pentetate
D000806:Angiotensin-Converting Enzyme Inhibitors; D007093:Imidazoles; D048289:Imidazolidines; C065166:imidapril; D012083:Renin; D016284:Technetium Tc 99m Pentetate