Hypertension and renal tumours: diagnosis and management

Sporadic cases of hypertension associated with renal tumours in childhood have been reported, but little is written on the incidence, severity, and management of these patients. We report five consecutive infants with renal tumours (three Wilms' tumours, one mesoblastic nephroma) and hypertension. The mean age was 12 months (range 2–34 months) and all tumours were stage I. Blood pressure was significantly elevated and labile in each patient. Preoperative renin levels were raised in all three patients in whom they were measured. Blood pressure was stabilised preoperatively in all cases. Perioperatively, invasive monitoring was employed and no blood pressure crises were encountered. Tumour removal was universally successful and the blood pressure returned to normal after antihypertensives were discontinued. These results suggest a high incidence of hypertension with infantile renal tumours. With preoperative control of blood pressure and perioperative monitoring, nephrectomy should be a safe procedure.