Key result
Surgical resection resolves hypertension in reninoma, which direct renin concentration detects despite normal renin activity.
Why the study?
Reninoma is rare and challenging to diagnose, especially in patients without elevated plasma renin activity, with refractory hypertension, or older age.
Case Report (n=3)
No
Reninoma should not be excluded in patients with refractory hypertension even if plasma renin activity is not elevated, and combining direct renin concentration, imaging, and selective vein sampling is critical for diagnosis.
May warrant reninoma consideration in refractory hypertension despite normal plasma renin activity; leaves open need for prospective diagnostic validation.
Background: Reninoma is rare and very challenging to diagnose. It is characterized by excessive renin secretion that causes severe hypertension and occurs more frequently in young females. Here, we compare and analyze three cases, which were not initially considered reninoma, because there was no increase in plasma renin activity (PRA), patients had refractory hypertension, or were older. Results: In two cases, PRA is normal or decreased but the direct renin concentration (DRC) is elevated. The third is in an older man with ambiguous imaging assessments and no evident lateralization of renal vein renin levels. Conclusions: Our findings suggest that the diagnosis of reninoma should not be completely excluded in patients with no elevated renin activity or refractory hypertension. In addition, a combination of blood tests and imaging analysis is highly recommended, and lateralization of renin levels is more applicable in cases where tumors are relatively small.
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Lv et al. (2026) conducted a case report in Reninoma (n=3). Retroperitoneal laparoscopic nephron-sparing tumor enucleation was evaluated on Normalization of blood pressure and direct renin concentration (DRC). Surgical resection of reninoma normalized blood pressure and direct renin concentration in all three patients, demonstrating that normal plasma renin activity does not exclude a reninoma diagnosis.
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