Malignant hypertension and hyperreninemia: primary or secondary hypertension? A case report

Submitted: 5 November 2020
Accepted: 30 December 2020
Published: 2 February 2021
Abstract Views: 1326
PDF: 541
HTML: 10
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Malignant hypertension is a rare condition characterized by severe hypertension and multi-organ ischemic damage. Marked activation of the renin-angiotensin system is observed in many patients, but its persistence over time is not known. We report a case of a 42-year-old woman who presented with severe hypertension and multi-organ damage. Initial evaluation showed an elevated value of direct renin concentration with normal plasma aldosterone concentration and a nodular lesion in the left adrenal gland. The differential diagnosis between the primary and secondary form of hypertension had to be questioned. Consequently, the patient was followed up for 20 months. Repeated checks showed a significant increase in renin levels with a normal aldosterone concentration and regression of organ damage. After 20 months, renin values returned within normal range. Hyperreninemia persisting over a long period of time has not been fully explained. Long-term follow-up allowed us to attribute malignant hypertension to de novo essential hypertension.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Cremer A, Amraoui F, Lip GYH, et al. From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency. J Hum Hypertens 2016;30:463-6. DOI: https://doi.org/10.1038/jhh.2015.112
van den Born B-JH, Lip GYH, Brguljan-Hitij J, et al. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother 2019;5:37-46. DOI: https://doi.org/10.1093/ehjcvp/pvy032
Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015;14:914-25. DOI: https://doi.org/10.1016/S1474-4422(15)00111-8
Oka K, Hayashi K, Nakazato T, et al. Malignant hypertension in a patient with primary aldosteronism with elevated active renin concentration. Intern Med 1997;36:700-4. DOI: https://doi.org/10.2169/internalmedicine.36.700
Maruhashi T, Amioka M, Kishimoto S, et al. Elevated plasma renin activity caused by accelerated-malignant hypertension in a patient with aldosterone-producing adenoma complicated with Renal Insufficiency. Intern Med 2019; 58:3107-11. DOI: https://doi.org/10.2169/internalmedicine.2327-18
Iimura O, Shimamoto K, Hotta D, et al. A Case of adrenal tumor producing renin, aldosterone, and sex steroid hormones. Hypertension 1986;8:951-6. DOI: https://doi.org/10.1161/01.HYP.8.10.951
Rossi GP, Bisogni V, Bacca AV, et al. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens 2020;5:1000292. DOI: https://doi.org/10.1097/01.hjh.0000745016.79540.85
van den Born B-JH, 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;20:900-6. DOI: https://doi.org/10.1016/j.amjhyper.2007.02.018
Derhaschnig U, Testori C, Riedmueller E, et al. Hypertensive emergencies are associated with elevated markers of inflammation, coagulation, platelet activation and fibrinolysis. J Hum Hypertens 2013; 27:368-73. DOI: https://doi.org/10.1038/jhh.2012.53
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356:411-7. DOI: https://doi.org/10.1016/S0140-6736(00)02539-3
Laragh JH, Baer L, Brunner HR, et al. Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease. Am J Med 52:633-52. DOI: https://doi.org/10.1016/0002-9343(72)90054-X
van den Born B-JH, Koopmans RP, Groeneveld JO, van Montfrans GA. Ethnic disparities in the incidence, presentation and complications of malignant hypertension. J Hypertens 2006;24:2299-304. DOI: https://doi.org/10.1097/01.hjh.0000249710.21146.38
McCune TR, Stone WJ, Breyer JA. Page kidney: case report and review of the literature. Am J Kidney Dis 1991;18:593-9. DOI: https://doi.org/10.1016/S0272-6386(12)80656-1
Mulatero P, Rabbia F, Milan A, et al. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension 2002;40:897-902. DOI: https://doi.org/10.1161/01.HYP.0000038478.59760.41
Mohammed S, Fasola AF, Privitera PJ, et al. Effect of methyldopa on plasma renin activity in man. Circ Res 1969;25:543-8. DOI: https://doi.org/10.1161/01.RES.25.5.543
Weidman P, Hirsch D, Maxwell MH, et al. Plasma renin and blood pressure during treatment with methyldopa. Am J Cardiol 1974;34:671-6. DOI: https://doi.org/10.1016/0002-9149(74)90156-8
McAllister RG, Michelakis AM, Oates JA, Foster JH. Malignant hypertension due to renal artery stenosis. Greater renin release from the nonstenotic kidney. JAMA 1972;221:865-8. DOI: https://doi.org/10.1001/jama.221.8.865
McLaren KM, MacDonald MK. Histological and ultrastructural studies of the human juxtaglomerular apparatus in benign and malignant hypertension. J Pathol 1983;139:41-55. DOI: https://doi.org/10.1002/path.1711390105

How to Cite

Belfiore, A., Palmieri, V. O., Pugliese, S., Ciannarella, M., Cezza, A., & Portincasa, P. . (2021). Malignant hypertension and hyperreninemia: primary or secondary hypertension? A case report. Italian Journal of Medicine, 15(2). https://doi.org/10.4081/itjm.2021.1419

List of Cited By :

Crossref logo