Ward Round-A rare tumor of the kidney resulting in hypertension, renal failure and a cerebrovascular accident in a young female

Abstract

A 17-year-old girl was admitted to our hospital with severe refractory hypertension evolving over approximately 4 years. Despite not having the resources to identify plasma-renin levels and using standard imaging techniques, a juxtaglomerular cell tumor was suspected and was histologically confirmed after surgical excision. This is a potentially lethal condition if left untreated and surgical excision is curative. The benign nature of the tumor is emphasized and its chemical, radiological and microscopic appearance discussed according to the literature. To the best of our knowledge, this is the first reported case of a patient surviving a cerebrovascular accident associated with a juxtaglomerular cell tumor. Case ReportA 17-year-old female was referred to our hospital with a fouryear history of hypertension. Initially this was associated with headaches but six months prior to referral she had suffered a cerebrovascular accident leading to a right hemiplegia. Her blood pressure was poorly controlled, despite being on Furosemide 40mg once daily, Losartan 50mg once daily, Methyldopa 500mg three times daily and Captopril 12.5mg three times daily. She had no known drug allergies and there was nothing else specific in her medical or family history. On examination her heart rate was 80 beats per minute and her blood pressure was 220/160. Her heart sounds were normal and her chest was clear. Her abdomen was soft and non-tender with no organomegaly or palpable masses. Initial investigations included full blood count, urea and electrolytes, twice daily blood pressure monitoring and an ultrasound scan of her abdomen. The results showed she was in renal failure with a urea of 74 mg/dL and creatinine of 5