జర్నల్ ఆఫ్ నెఫ్రాలజీ & థెరప్యూటిక్స్

Kidney Tumor in Pregnancy

Abstract

Manuela Stoicescu *

Background: The main objectives of this clinical case presentation were to determine the real cause of a young hypertensive pregnant patient.
Methods: I present the clinical case of a young women patient age 21, pregnant in 32 weeks, which came for a consult because she had headache, dizziness and bilateral symmetric white and soft oedema of the legs. Her blood pressure value was determined as being BP=220/130 mmHg. The urinary examination had shown a proteinuria 20 g/dl. A hypotensive treatment was innitiated with allowed medication during the pregnancy, but the blood pressure values do not completely normalize BP=160/90 mmHg. Because the patient had bilateral lumbar pains an abdominal ultrasound was performed, although innitialy these symptoms were interpreted as being linked to the pregnancy, and surprisingly
a left renal tumor formation of 4,5/3,5 cm was discovered. The plasma renin level was determined as being 198 ng/ ml because of the excess secretion of this substance by the renal cell tumour. The presence of the proteinuria and the lumbar pains should not be interpreted only within the pregnancy context, as these could have also other causes, as the renal cell tumour just like in the above mentioned case. After the patient had given birth, an abdominal CT was performed and confirmed the presence of the right kidney tumor and also a i.v. Urography was performed and showed lacuna image at the level of the right kidney. After the patient had given birth, a right nephrectomy was performed ,and the histopathological examination from the tumour formation that has been extracted and releaved clear cell renal carcinoma.
Results: The presence of the arterial hypertension and proteinuria is difficult to interpretation in context of pregnancy. Usually, in the last weeks of the pregnancy presence of the proteinuria and high blood pressure and bilateral symmetric white and soft oedema of the legs should not be interpreted only within the pregnancy context, as these could have also other causes, as the renal cell tumour just like in the above mentioned case.
Conclusions: The plasma renin level must be performed as a screening test in young pregnant patients, because the blood pressure, as a real cancer marker can draw the attention upon a renal cell tumour diagnosis, not being interpreted only as high blood pressure in the pregnancy context as possible preeclampsia-eclampsia imminence.