Refractory Hypertension in Infantile-Onset Denys-Drash Syndrome.

Abstract

Denys-Drash syndrome is characterized by progressive nephropathy, gonadal dysgenesis, and Wilms tumor caused by a WT1 gene mutation. Infants with Denys-Drash syndrome frequently experience severe hypertension, but detailed clinical manifestations have yet to be clarified. Cases of infantile-onset Denys-Drash syndrome with severe hypertension at our hospital were retrospectively analyzed and the pathogenesis of hypertension was investigated. Six infants who received the diagnosis of Denys-Drash syndrome at the median age of 10 days (range: 2-182 days) were enrolled. Five infants had the complication of severe hypertension within a few days of diagnosis. All the patients showed rapid progression to end-stage renal disease and urgently required dialysis due to anuria/oliguria and hypervolemia with a median duration of 7.5 days (range: 0-17 days) on the day after diagnosis. Even under dialysis, all the patients continued to need antihypertensive treatment. Five patients underwent a preventive nephrectomy for Wilms tumor, and one patient underwent a nephrectomy due to progression to Wilms tumor. Two patients developed hypotension after a nephrectomy. The main causes of hypertension were hypervolemia in the predialysis stage, renin-associated hypertension in the dialysis stage, and multiple factors, including increased plasma catecholamine-associated hypertension in the postnephrectomy dialysis stage. At last the follow-up after bilateral nephrectomy, four of the five patients required antihypertensive treatment. Not all the patients showed target organ complications caused by hypertension. Severe hypertension is a common complication of infantile-onset Denys-Drash syndrome. The possibility of hypotension after nephrectomy should be considered in patients with Denys-Drash syndrome.

• Authors: Kentaro Nishi, Koichi Kamei, Masao Ogura, Mai Sato, Miki Murakoshi, Chikako Kamae, Ryutaro Suzuki, Toru Kanamori, China Nagano, Kandai Nozu, Kenji Ishikura, Shuichi Ito
• Journal: The Tohoku journal of experimental medicine (Tohoku J Exp Med) Vol. 252 Issue 1 Pg. 45-51 (09 2020) ISSN: 1349-3329 [Electronic] Japan
• PMID: 32863338 (Publication Type: Journal Article)

Topics

• Age of Onset
• Denys-Drash Syndrome (complications, surgery)
• Humans
• Hypertension (complications, surgery)
• Hypotension (complications)
• Infant
• Infant, Newborn
• Nephrectomy
• Organ Specificity