Hypertension affects 34% of adults, two thirds of which are reportedly uncontrolled according to the 2017-2018 National Health Survey. In light of strong Australian research, our Endocrine testing units are testing more of these high-risk patients and identifying more primary aldosteronism and low renin hypertension. The lesser prevalent secondary aldosteronism, due to high plasma renin, can rarely be uncovered with the aldosterone/renin screen.
A reninoma is a rare functional tumour of afferent arteriolar juxtaglomerular cells that secretes renin, leading to hyperactivation of the renin-angiotensin-aldosterone system. While the hypertension from reninoma may be severe, resection is usually curable, highlighting the importance of accurate diagnostics.
This practical guide to the work up of reninoma uses a clinical case and physiological principles to illustrate optimal preparation for biochemical investigation and renal vein sampling.