A 42-year-old woman with worsening hypertension

WHAT IS THE CAUSE OF WORSENING HYPERTENSION?

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DISCUSSION

Computed tomography (CT) showed a left kidney that measured 13.0 x 4.5 cm, with marked parenchymal atrophy due to severe hydronephrosis (Figure 1A). The hydronephrosis extended to the left adnexal region where there was a mass measuring 5.0×3.0x2.5cm, suggestive of teratoma (Figure 2). Futhermore, the CT revealed a diffusely narrowed left renal artery, without stenosis (Figure 1B). The patient was underwent a left nephrectomy and excision of the mass by videolaparoscopy. The anatomopathological assessment of the adnexal mass was compatible with a mature cystic teratoma. A 24h Ambulatory Blood-Pressure Monitoring, carried out 4 months after the surgery, showed adequate BP control with a mean BP level of 117/78mmHg

Benign ovarian masses rarely cause uretheral obstruction or hydronephrosis. Although it is uncommon, it is important to remember that unilateral hydronephrosis can cause or aggravate hypertension. The mechanism is unclear but the renin-angiotensin system (RAS) has been found to be activated unilaterally in acute obstruction.

ANSWER: OBSTRUCTIVE UROPATHY FROM AN OVARIAN TERATOMA

REFERENCES:

Weidmann P; Beretta-Piccoli C; Hirsch D; Reubi FC; Massry SG. Curable hypertension with unilateral hydronephrosis. Studies on the role of circulating renin. Ann Intern Med 1977 Oct;87(4):437-40.

CORRESPONDANCE

Natalia C V Melo, Elerson C Costalonga, Monique S Fontes, Alexandre B Pedreira, Jose L Santello, Jose N Praxedes, Renal Division, University of S?o Paulo School of Medicine, S?o Paulo, Brazil. mailto Natalia Melo