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
P.D. Hinduja National Hospital & Medical Research Centre, V.S. Marg, Mahim, Mumbai - 400 016
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
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.
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.  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. 
Hypertension as the only presenting symptom in renal cell carcinoma is rare.  In one study, almost all the patients who had hypertension due to renal cell carcinoma also had one or more other symptoms. 
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.
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