Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 19  |  Issue : 1  |  Page : 80--81

Renal cell carcinoma presenting as hypertension


Dharm Raj Singh, K Gaitonde, N Santoshi, N Patil, V Srinivas 
 Department of Urology and Uro-Oncology, P.D. Hinduja National Hospital, Mumbai, India

Correspondence Address:
V Srinivas
P.D. Hinduja National Hospital & Medical Research Centre, V.S. Marg, Mahim, Mumbai - 400 016
India

Abstract

A case of renal cell carcinoma presenting as hyperten­sion is described with a brief review of the literature. Iso­lated hypertension is a rare form of presentation and shows the potential of reversibility of hypertension after surgical extirpation of the tumour



How to cite this article:
Singh DR, Gaitonde K, Santoshi N, Patil N, Srinivas V. Renal cell carcinoma presenting as hypertension.Indian J Urol 2002;19:80-81


How to cite this URL:
Singh DR, Gaitonde K, Santoshi N, Patil N, Srinivas V. Renal cell carcinoma presenting as hypertension. Indian J Urol [serial online] 2002 [cited 2020 Nov 28 ];19:80-81
Available from: https://www.indianjurol.com/text.asp?2002/19/1/80/37396


Full Text

 Case Report



A 39-year-old male complained of headache and palpi­tation of a few weeks' duration. He was subsequently di­agnosed to have hypertension (BP=190/120 mmHg) at an outside hospital. He was put on amlodepine and a tranquilizer for blood pressure. Physical examinations in­cluding fundoscopy was essentially normal. His serum creatinine was 0.9 mg/dl and hemoglobin was 14.6 gm/dl. The urinalysis was normal. He continued to have high blood pressure (140/100 mmHg) despite the medication. He was subjected for further investigations to determine the aetiology of the hypertension. 24 hour urinary vanilly­mandelic acid was normal. Ultrasonography and CT scan of abdomen revealed a 4.5 cm well circumscribed, mixed density, enhancing mass confined to the left kidney with­out any lymph nodes or vascular thrombus. Metastatic work-up including liver function tests, chest x-ray and bone scan were normal. A clinical diagnosis of renal carcinoma was made and he was subjected to a left radical nephrec­tomy. The postoperative period was uneventful. His blood pressure became normal postoperatively and he did not require any antihypertensive medicine. The histopathol­ogy revealed stage I, grade III renal cell carcinoma (clear cell type). The patient is asymptomatic at 6 months of fol­low-up and his blood pressure is normal without any anti­hypertensive drugs.

 Comments



The incidence of renal cell carcinoma in United States is 2700 cases in a year. It constitutes 3% of adult cancer cases' of and 85% of all renal tumours. The common pre­senting symptoms are hematuria (60%), pain (40%) and abdominal mass (40%). This classical triad occurs in about 10% of cases. Although most of the patients present with one of the above symptoms, renal cell carcinoma can pro­duce a variety of para-neoplastic symptoms mimicking other illnesses like anemia, hypercalcemia, fever, hyper­tension, raised erythrocyte sedimentation rate (ESR), and Stauffer's syndrome. It may be due to the local effect of the tumor or due to secretion of hormonelike substances from the tumour.

Hypertension is reported in 14% to 35% of patients pre­senting with paraneoplastic syndrome. [1] Various mecha­nisms proposed for the etiology of hypertension in renal cell carcinoma are hyperreninemia, renal arteriovenous fistula, polycythemia, hypercalcemia, ureteral obstruction and elevated intracranial pressure secondary to cerebral metastasis. [2]

Hypertension as the only presenting symptom in renal cell carcinoma is rare. [1] In one study, almost all the pa­tients who had hypertension due to renal cell carcinoma also had one or more other symptoms. [3]

This case highlights that rarely renal cell carcinoma is the sole cause of hypertension and this fact should be borne in mind while working up hypertensive patients. If diag­nosed early, the hypertension is reversible with surgery and the patient can avoid unnecessary medication. More importantly, the tumour is removed at a curable stage and the overall prognosis can be excellent.

References

1Moein MR, Dehghani VO. Hypertension : A rare presentation of renal cell carcinoma. J Urol 2000 (Dec); 164(6): 2019.
2Sufrin G, Chasan S. Golio A et al. Paraneoplastic and serologic syndromes of renal adenocarcinoma. Semin Urol 1997: 7 : 158­-171.
3Trifa M, Langer W, Hadj Slimane M et at. Renal cell adenocarci­norna : report of 64 cases. Ann Urol (Paris) 1997: 31: 117.