Anesthetic management for percutaneous computed tomography-guided radiofrequency ablation of reninoma: a case report

Abstract

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension.

Minimally Invasive Surgery-Based Multidisciplinary Clinical Management of Reninoma: A Single-Center Study

“…The potential for hemodynamic fluctuations during the surgical resection of reninoma has not yet been well described. According to our observations, there were no significant fluctuations in blood pressure during the operation in any of the 9 cases, which is consistent with previous reports [29,30].…”

Juxtaglomerular cell tumor diagnosed preoperatively by renal tumor biopsy

“…In most cases, clinical presentations, such as hypertension, caused by the tumor have improved after tumor resection. In one case, severe drop of blood pressure after ablation of tumor was reported 11 . A saline infusion improved the blood pressure in the case.…”

Reninoma: a rare cause of curable hypertension

“…An abdominal CT performed to diagnose acute appendicitis incidentally detected the JCT, and the tumor was diagnosed based on biopsy and investigations revealing high renin activity and angiotensin levels. She was treated using CT-guided percutaneous radiofrequency ablation (RFA) [9].…”

“…However, occasionally, radical nephrectomy may be required for deep-seated masses [4]. Additionally, percutaneous RFA can be a useful therapeutic option as described in the 19-year-old Korean woman's case [9]. However, although RFA may be less invasive compared with surgical resection, RFA should be considered cautiously because long-term follow-up over more than 2 years has not been reported with this procedure [14].…”