How Does Wilms Tumor Causes Hypertension?

Hypertension is associated with many of the childhood cancers such as Wilms’ tumor (WT), pheochromocytoma, neuroblastomas, and brain tumors. The cause of this hypertension in the above-mentioned cancers can be due to many factors such as increased renin secretion by the tumor, secretion of glucocorticoids or catecholamines, renal vascular compression by the mechanical mass effect, pain associated with cancer due to steroid chemotherapy or due to increased intracranial pressure.

How Does Wilms Tumor Cause Hypertension?

How Does Wilms Tumor Cause Hypertension?

A retrospective study was done on “renin-induced hypertension in Wilms’ tumor patients” 86 children with Wilms’ tumor participated and all patients underwent chemotherapy before surgery, then tumor nephrectomy surgery was done and postoperatively chemotherapy and radiotherapy were given. All patients’ blood pressure was recorded electronically and, in some patients, blood was taken to measure the serum renin levels. A child who had increased blood pressure (according to age and gender) on 3 consecutive days was diagnosed as hypertensive. Of the 86 patients, 47 (55%) patients had hypertension and in 44 patients from the study (31 hypertensive patients and 13 normotensive patients) plasma renin levels were checked. Out of the 31 hypertensive patients, 25 (81%) had increased renin levels, 6 (19%) patients from the normotensive group also had increased renin levels. 19 patients who were diagnosed with hypertension were in the tumor stage III and IV, this suggests that hypertensive patients with Wilms’ tumor have a poor outcome compared to the normotensive patients. There was no difference in tumor volume in hypertensive and normotensive patients. 28 patients from the 47 hypertensive patients were treated with antihypertensives before surgery, angiotensin-converting enzyme inhibitors (ACEI) were given for 21 patients, beta-blockers for 6 patients and calcium channel blockers (CCB) for 1 patient. The blood pressure became normal in 19 patients treated with ACEI and in 6 patients treated with beta-blockers and CCB. Out of the remaining 19 patients with hypertension 18 became normotensive before surgery. Following tumor nephrectomy, except for four patients, all other patients became normotensive. (1) (2)

According to this study, the main cause of hypertension in Wilms’ tumor is due to increased renin secretion (primary hyperreninemia) either due to intra-renin vascular compression or due to the production of renin from tumor cells as the majority of patients became normotensive after tumor nephrectomy. Production of renin is controlled by the renin-angiotensin system which plays an important role in the blood pressure homeostasis. The renin-angiotensin system promotes angiogenesis, tumor progression and cell proliferation. Secondary hyperreninemia where renin production by the normal kidney tissue can occur due to secondary ischemia by the tumor mass, entrapment of glomeruli, and compression of the renal artery branches by tumor localization which all leads to activation of the renin-angiotensin system. Peptide hormones that regulate blood pressure can also cause hypertension as some Wilms’ tumor patients with hypertension to have normal renin levels.

Another study was done on “The prognostic significance of hypertension at diagnosis in children with Wilms tumor” shows that Wilms’ tumor patients with hypertension had treatment failures like tumor relapse, tumor progression, and death than the normotensive group. Relapses were seen in both hypertensive and normotensive patients however, the tumor progression and death were high in the hypertensive group (20%) as a first event. Therefore, Wilms’ tumor patients with hypertension at diagnosis have a poor outcome compared to normotensive patients. (1) (2) (3)

Conclusion

Hypertension is associated with many of the childhood cancers such as (Wilms’ tumor, pheochromocytoma, neuroblastomas, and brain tumors. The main cause of hypertension in Wilms’ tumor is due to increased renin secretion (primary hyperreninemia) either due to intra-renin vascular compression or due to the production of renin from tumor cells. Secondary hyperreninemia where renin production by the normal kidney tissue can occur due to secondary ischemia by the tumor mass, entrapment of glomeruli, and compression of the renal artery branches by tumor localization which all leads to activation of the renin-angiotensin system. Peptide hormones that regulate blood pressure can also cause hypertension. According to studies patients with hypertension at the diagnosis of Wilms’ tumor have poor prognosis than the normotensive patients with Wilms’ tumor.

References:

Also Read:

Was this article helpful?

Yes No
×

Suggestions to Improve the Article

This article contains incorrect information.

This article does not have the information I am looking for.


I Have a Medical Question.

Ask A Doctor Now

If you are facing a medical emergency, call your local emergency services immediately, or visit the nearest ER or urgent care facility
×

Suggestions to Improve the Article

×

How Did This Article Help?

This Article Did Change My Life!


I Have a Medical Question.

Ask A Doctor Now

If you are facing a medical emergency, call your local emergency services immediately, or visit the nearest ER or urgent care facility
×

Thank you for your feedback.