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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 151-152
Remission of arterial hypertension after the treatment of a giant renal cyst


1 Department of Nephrology, Fattouma Bourguiba Hospital, Monastir, Tunisia
2 Department of Radiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
3 Department of Urology, Fattouma Bourguiba Hospital, Monastir, Tunisia

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Date of Web Publication30-Dec-2010
 

How to cite this article:
Aloui S, Bouraoui S, Salem R, Toffahi M, Skhiri H, Frih A, Dhia NB, Elmay M. Remission of arterial hypertension after the treatment of a giant renal cyst. Saudi J Kidney Dis Transpl 2011;22:151-2

How to cite this URL:
Aloui S, Bouraoui S, Salem R, Toffahi M, Skhiri H, Frih A, Dhia NB, Elmay M. Remission of arterial hypertension after the treatment of a giant renal cyst. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Aug 23];22:151-2. Available from: http://www.sjkdt.org/text.asp?2011/22/1/151/74380
To the Editor,

Simple renal cysts are acquired kidney le­sions and are usually an incidental ultrasound finding. Their frequency increases with age, and achieves more than 30% after 70 years. [1] They are generally considered as a harmless anomaly, although cases of complicated renal cysts have been reported. Most complications are spontaneous rupture, infections and hemor­rhage. [2] Hypertension rarely complicates a re­nal cyst. We present a 58-year-old woman re­ferred to our unit for severe hypertension. She had a history of right nephrectomy in 1961 for pyonephrosis. Physical examination revealed an arterial hypertension (200/100 mmHg). Other systemic examinations were unremar­kable. She was treated with acebutolol 400 mg/day. Laboratory investigations were within normal limits: serum creatinine 93 μmol/L; he­moglobin 14.2 g/dL; glucose 5.2 mmol/L; po­tassium 4.2 mmol/L; and urinalysis was ne­gative for proteinuria and hematuria. Ultraso­nography and computed tomography showed a giant left renal cyst measuring 14.4 cm × 11 cm in the median area and the lower pole com­pressing the kidney. The renal pelvis and ca­lyces revealed stagnation of the contrast media [Figure 1].
Figure 1: Computed tomography scan showing a simple giant left (and single) renal cyst with compression and displacement of the kidney.

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The cyst was managed by surgery. Pathologic examination of the specimen revealed a sphe­rical, smoothed surfaced with a serous, sub­yellow content and concluded to a non compli­cated renal cyst. Immediately and 3 years post­ operatively, the blood pressure is still normal (120/70 mmHg) without any therapy.

The association of simple renal cyst and hy­pertension has been previously reported. [3],[4],[5],[6] Lo­cal renal ischemia, caused by cyst expansion, leads to stimulation of the renin-angiotensin- aldosterone system and hypertension. [6] Johnson et al [5] and Churchill et al [6] found a high-renin activity in the vein of a kidney affected by a large simple cyst. In addition, angiotensin II increases the filtration fraction at the glome­rulus and increases sodium reabsorption, which leads to tissue hypoxia by increasing the renal oxygen consumption. [7] In our case, we did not document a laboratory evidence of renal hyper­tension such as renin levels. The association between simple renal cysts and higher arterial blood pressure probably arises from the under­lying renal disease causing both. Remission of hypertension after surgical cyst cure proves its relationship with the renal cyst.

 
   References Top

1.Laucks SP Jr, McLachlan MS. Aging and simple renal cysts of the kidney. Br J Radiol 1981;54:12-4.  Back to cited text no. 1
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2.Delongchamps NB, Peyromaure M. Cystic disease of the kidney. Anns Urol 2006;1:1-14.  Back to cited text no. 2
    
3.Pedersen JF, Emamian SA, Nielsen MB. Sig­nificant association between simple renal cyst and arterial blood pressure. Br J Urol 1997;79: 688-91.  Back to cited text no. 3
[PUBMED]    
4.Lezrek M, Fassi-Fehri H, Badet L, et al. Remission of erythrosis and hypertension after treatment of giant renal cyst. Urology 2002; 60:164i-164ii.  Back to cited text no. 4
    
5.Johnson JD, Radwin HM. High renin hyper­tension associated with renal cortical cyst. Urology 1976;7(5):508-11.  Back to cited text no. 5
    
6.Giannakopoulos X, Charalabopoulos K, Chara­labopoulos A, Golias CH, Peschos D, Sofikitis N. Giant simple renal cyst complicated with hypertension. Int J Clin Pract Suppl 2005;147: 69-71.  Back to cited text no. 6
    
7.Donnelly S, Shah BR. Erythropoietin deficiency in hyporeninemia. Am J Kidney Dis 1999;33: 947-53.  Back to cited text no. 7
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Correspondence Address:
Sabra Aloui
Department of Nephrology, Fattouma Bourguiba Hospital, Monastir
Tunisia
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PMID: 21196636

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