Laparoscopic nephro-sparing surgery of juxtaglomerular cell tumor in a child.
OBJECTIVE
To report a case of juxtaglomerular cell tumour of the kidney (reninoma) in a child treated with laparoscopic nephron-sparing surgery.


RESULTS
A 14-year-old girl was incidentally found to have hypertension (180/114 mmHg) at the time of adenotonsillectomy. Pre-operative investigations revealed a plasma renin level of 225.9 ng/dl (4.4-46), normal aldosterone, cortisol and urinary catecholamine. Abdominal ultrasound detected a 1.9 × 1.5-cm hypoechoic lesion in the right kidney lower pole; CT scan confirmed the presence of a 1.5-cm, circumscribed, solid, hypoenhancing cortical lesion in the right lower pole. Laparoscopic nephron-sparing surgery was accomplished by clamping the renal artery for 30 min; after excision, the tumour bed was closed using barbed V-loc sutures. The procedure was completed laparoscopically in 150 min with no peri-operative complications. The patient was discharged home on day 4 postoperatively. Histology confirmed the diagnosis of a juxtaglomerular cell tumour that was completely excised. The J-J stent was removed 1 month later. At follow-up, the patient's blood pressure was normalized and medications were stopped. A DMSA scan confirmed 36% residual right kidney function.


CONCLUSIONS
Laparoscopic nephron-sparing surgery should be considered in children with juxtaglomerular tumours. This technique allows prompt recovery with preservation of significant renal function.
Department of Paediatric Urology, Royal Children Hospital, Melbourne, Australia. Electronic address: maurizio.pacilli@nhs.net.
M
M
Pacilli
Department of Paediatric Urology, Royal Children Hospital, Melbourne, Australia.
M
M
O'Brien
Department of Paediatric Urology, Royal Children Hospital, Melbourne, Australia.
Y
Y
Heloury
D000293:Adolescent; D005260:Female; D006801:Humans; D007606:Juxtaglomerular Apparatus; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments
Juxtaglomerular cell tumor; Partial nephrectomy; Reninoma