title: Focal Segmental Glomerulosclerosis Secondary to Juxtaglomerular Cell Tumor during Pregnancy: A Case Report.
abstract: Juxtaglomerular cell tumor is a rare renal neoplasm. Secondary hypertension with juxtaglomerular cell tumor can be seen in females in their 20s and 30s. We present a case of juxtaglomerular cell tumor during pregnancy. A 32-year-old female was hospitalized for refractory hypertension and nephrotic syndrome in the 23rd gestational week. One year before admission, she had been diagnosed with hypertension; plasma renin activity at that time had been 2.3 ng/ml/h. Her blood pressure was uncontrolled during pregnancy, and proteinuria was detected in the 12th gestational week despite the administration of antihypertensive medications. Laboratory data showed proteinuria, hypokalemia, and hypoalbuminemia. In the 25th gestational week, she underwent surgical termination of the pregnancy because of congestive heart failure and acute renal injury. After the termination of the pregnancy and the delivery of a viable fetus, her hypertension and nephrotic syndrome were found to persist with a high plasma renin activity (13 ng/ml/h). Ultrasonography showed a 5.5-cm left renal cystic mass with a partially solid component at the lower renal pole. The left kidney with the renal mass was excised by laparoscopic nephrectomy. Plasma renin activity normalized the next day, with a decrease in blood pressure to 120-130/80-90 mm Hg; however, proteinuria remained at ≥3.5 g/day. On the basis of histopathological findings, the patient was diagnosed with a juxtaglomerular cell tumor and focal segmental glomerulosclerosis. Juxtaglomerular cell tumor is a rare renin-secreting tumor associated with refractory hypertension in young females and is a possible cause of hypertension during pregnancy.
authors.affiliation: Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Surgical Pathology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Aoki
authors.affiliation: Department of Urology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sakai
keywords: Focal segmental glomerulosclerosis; Hypertension; Pregnancy; Renin secretion