-Case Reports-

Hypertensive Cardiomyopathy with Congestive Heart Failure in an Infant with Unilateral Wilms Tumor: A Case Report

Jun Kuwabara¹, Satoshi Akita¹, Mitsunori Sato¹, Katsuya Watanabe¹, Takayasu Kawamoto¹, Kazufumi Tanigawa¹, Sayuri Matsui¹, Yusuke Matsuno², Yousuke Abe², Satoshi Kikuchi¹, Motohira Yoshida¹, Shigehiro Koga¹, Kei Ishimaru¹, Hiroyuki Egi¹ and Yuji Watanabe¹

¹Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Ehime, Japan
²Department of Surgery, Saijo Central Hospital, Ehime, Japan

Wilms tumor (WT) is the most common malignant kidney tumor in children. High blood pressure is seen in up to 55% of children with WT. However, hypertensive cardiomyopathy with congestive heart failure due to WT is remarkably rare, with only several cases reported worldwide. In this report, a pediatric case of WT with hypertension causing hypertensive cardiomyopathy and congestive heart failure is presented. An 8-month-old male child with abdominal distension was seen by his primary physician. He was referred to our hospital for further examination and treatment. Abdominal contrast-enhanced computed tomography demonstrated a weakly enhancing, large abdominal mass, which was larger than 12 cm. Two-dimensional transthoracic echocardiography showed a diffuse hypokinetic left ventricle. The patient was diagnosed with cardiomyopathy caused by hypertension. Open surgical resection of the mass was successfully performed. His postoperative course was uncomplicated, and the patient was successfully discharged. The plasma renin activity was maintained at a high level even after left nephrectomy, suggesting that the right kidney was likely the source of renin secretion. Mechanical compression of the right renal blood vessels by a greatly enlarged left kidney can cause right renal ischemia, which activates renin excretion. Nephrectomy can be an effective treatment for a WT patient with hypertension causing hypertensive cardiomyopathy, and then cardiac function will be improved within several weeks. We recommend routine echocardiography surveillance in patients with WT. This report can help pediatric surgeons become more familiar with cardiomyopathy caused by WT.

J Nippon Med Sch 2021; 88: 551-555

Keywords
Wilms tumor, hypertensive cardiomyopathy, hypertension, renin

Correspondence to
Mitsunori Sato, Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 790-0295, Japan
mit-sato@m.ehime-u.ac.jp

Received, July 30, 2020
Accepted, October 28, 2020