Skip to main content

Advertisement

SpringerLink
Log in

A case of malignant nephrosclerosis occurring with serum renin in the normal range

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

A 37-year-old Japanese man was admitted to our hospital for evaluation of severe hypertension and visual impairment. His serum creatinine was 4.16 mg/dL. Plasma renin activity was normal (2.7 ng/mL/h), but plasma aldosterone concentration was elevated (27.2 ng/dL). A kidney biopsy showed concentric subendothelial edematous thickening of the arterioles (onion skin pattern) with luminal narrowing or obstruction, and malignant nephrosclerosis was diagnosed. Antihypertensive therapies, including an angiotensin II receptor blocker and spironolactone, were administered and effectively preserved kidney function and normalized blood pressure. This case indicates that hyperaldosteronemia in the presence of normal renin levels might also cause malignant hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ACTH:

Adrenocorticotropic hormone

ARB:

Angiotensin II type 1 receptor blocker

eGFR:

Estimated glomerular filtration rate

PRA:

Plasma renin activity

PAC:

Plasma aldosterone concentration

References

  1. Sarafidis PA, Bakris GL. Evaluation and treatment of hypertensive urgencies and emergencies. In: Johnson RJ, Feehally J, Floege J, editors. Comprehensive clinical nephropathy. 5th ed. Mosby Elsevier: Philadelphia; 2015. p. 439–46.

    Google Scholar 

  2. Januszewicz A, Guzik T, Prejbisz A, Mikołajczyk T, Osmenda G, Januszewicz W. Malignant hypertension: new aspects of an old clinical entity. Pol Arch Med Wewn. 2016;126(1–2):86–93.

    Google Scholar 

  3. van den Born BJ, Koopmans RP, van Montfrans GA. The renin-angiotensin system in malignant hypertension revisited: plasma renin activity, microangiopathic hemolysis, and renal failure in malignant hypertension. Am J Hypertens. 2007;20(8):900–6.

    Article  Google Scholar 

  4. Nonaka K, Ubara Y, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Sawa N, Takaichi K, Kuroda Y, Ohashi K. Clinical and pathological evaluation of hypertensive emergency-related nephropathy. Intern Med. 2013;52(1):45–53.

    Article  CAS  Google Scholar 

  5. Shera AH, Baba AA, Bakshi IH, et al. Recurrent malignant juxtaglomerular cell tumor: a rare cause of malignant hypertension in a child. J Indian Assoc Pediatr Surg. 2011;16:152–4.

    Article  Google Scholar 

  6. Prejbisz A, Antoniewicz AA, Kabat M, et al. Reninsecreting juxtaglomerular cell tumor of the kidney causing severe hypertension and polyuria. Pol Arch Med Wewn. 2014;124:207–8.

    Google Scholar 

  7. Shantsila A, Lip GYH. Malignant Hypertension Revisited-Does This Still Exist? Am J Hypertens. 2017;30(6):543–9.

    Article  Google Scholar 

  8. Byrd JB, Turcu AF, Auchus RJ. Primary aldosteronism: practical approach to diagnosis and management. Circulation. 2018;138(8):823–35.

    Article  CAS  Google Scholar 

  9. Zarifis J, Lip GY, Leatherdale B, Beevers G. Malignant hypertension in association with primary aldosteronism. Blood Press. 1996;5(4):250–4.

    Article  CAS  Google Scholar 

  10. Prejbisz A, Klisiewicz A, Januszewicz A, et al. 22-Year-old patient with malignant hypertension associated with primary aldosteronism. J Hum Hypertens. 2013;27:138–40.

    Article  CAS  Google Scholar 

  11. Oelkers W, Diederich S, Bähr V. Primary hyperaldosteronism without suppressed renin due to secondary hypertensive kidney damage. J Clin Endocrinol Metab. 2000;85(9):3266–70.

    Article  CAS  Google Scholar 

  12. Koshiyama H, Fujisawa T, Kuwamura N, Nakamura Y, Kanamori H, Oida E, Hara A, Suzuki T, Sasano H. A case of normoreninemic aldosterone-producing adenoma associated with chronic renal failure: case report and literature review. Endocrine. 2003;21(3):221–6.

    Article  CAS  Google Scholar 

  13. Kubo H, Tsurutani Y, Inoue K, Watanabe K, Yamazaki Y, Sunouchi T, Hoshino Y, Hirose R, Katsuragawa S, Tannai H, Shibahara Y, Kakuta Y, Matsui S, Saito J, Omura M, Sasano H, Nishikawa T. Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression. PLoS One. 2022;17(4): e0267732.

    Article  CAS  Google Scholar 

  14. Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Relationships of plasma renin levels with renal function in patients with primary aldosteronism. Clin J Am Soc Nephrol. 2007;2(4):722–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan

    Masato Sawamura, Naoki Sawa, Yoichi Oshima, Daisuke Ikuma, Masayuki Yamanouchi, Noriko Hayami, Akinari Sekine, Hiroki Mizuno, Eiko Hasegawa, Tatsuya Suwabe, Junichi Hoshino & Yoshifumi Ubara

  2. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    Kei Kono, Keiichi Kinowaki & Kenichi Ohashi

  3. Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

    Naoki Sawa, Tatsuya Suwabe, Junichi Hoshino & Yoshifumi Ubara

  4. Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Ohashi

Authors
  1. Masato Sawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoichi Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Ikuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masayuki Yamanouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Noriko Hayami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akinari Sekine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroki Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eiko Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tatsuya Suwabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Junichi Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kei Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Keiichi Kinowaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kenichi Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yoshifumi Ubara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshifumi Ubara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The present case report was produced in conformity with the Declaration of Helsinki, and the patient gave consent for the report to be published.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sawamura, M., Sawa, N., Oshima, Y. et al. A case of malignant nephrosclerosis occurring with serum renin in the normal range. CEN Case Rep 12, 116–121 (2023). https://doi.org/10.1007/s13730-022-00726-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-022-00726-x

Keywords

Search

Navigation