若年発症のレニン依存性高血圧症の1例

A Case of Juvenile Onset Renin Dependent Hypertension

　17歳，男性．生来健康であったが偶然血圧高値を指摘され，高血圧の精査加療目的にて当科入院．受診時血圧222／142mmHg，眼底はScheie分類H₃S₃，血漿レニン活性11ng／ml／hrと高値を示したため，二次性高血圧症を疑い，カプトプリル負荷レノグラフィを施行．降圧とともに両側腎の血流低下および排泄遅延が認められたことから両側腎血管性高血圧症が示唆された．しかし，選択的腎動脈造影により，両側腎動脈および主要分枝に有意な狭窄性病変を認めず，レニン依存性高血圧と診断した．画像診断において明らかな占拠性病変は認められなかったが，本症例はレニン産生腫瘍などのprimary relninisnnに進展する可能性があり，今後注意深い観察が必要と思われる．

A 17 years old boy with a recent onset of hyperten-sion. hypertensive retinopathy and left ventricular hypertrophy exhibited markedly elevated plasma renin activity (PRA). Captoril loading increased PRA by more than 200% and renal scintigraphy showed a showdown of the excretion phase bilaterally, suggesting renovas-cular hypertension due to bilateral renal artery stenosis. However, selective renal artery angiography revealed no stenotic lesion. Blood pressure was lowered by a small dose of angiotensin converting enzyme inhibitor. This case may indicate primary reninism although no mass lesion was documented by abdominal computed tomography. Careful] follow up is necessary for possible development of a renin secreting tumor.