Severe hyperreninemic hypertension associated with spontaneous renal cholesterol crystal embolization

Clinical and Experimental Nephrology
Masami TanakaKimihiko Matsuyama

Abstract

A 70-year-old man was admitted because of severe hypertension and renal insufficiency. Marked elevation in plasma renin activity (PRA; 34.2 ng/ml per h) was noted. Five days later, the patient developed hemorrhagic duodenal ulcers and panperitonitis, went into shock, and died. An autopsy revealed severe atherosclerosis with marked ulceration in the abdominal aorta. Renal histology showed multiple cholesterol crystal embolization (CCE) associated with infarction. Cholesterol crystals were also detected in the vessels of the gastrointestinal system, including the liver, stomach, colon, and pancreas. Although not common, spontaneous CCE should be considered in elderly patients who present with abrupt onset of severe hypertension associated with renal insufficiency. The most important finding in this patient was severe hyperreninemia. Although potentiation of the renin-angiotensin-aldosterone system is the suggested mechanism for the hypertension in renal CCE, we could not find any reported case of renal CCE with hyperreninemia. It is reasonable to consider that severe hyperreninemia might be overlooked in renal CCE. PRA should be measured in patients with renal CCE, because it may give important information for selecting antihyper...Continue Reading

Citations

Dec 8, 2009·Circulation Journal : Official Journal of the Japanese Circulation Society·Tomoko Machino-OhtsukaKazutaka Aonuma
May 26, 2017·International Journal of Molecular Sciences·Xuezhu LiShougang Zhuang
Apr 7, 2007·The American Journal of Surgical Pathology·Chi K Lai, Parmjeet S Randhawa

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