ORIGINAL ARTICLE G.P. Hadley Æ M. Mars Hypertension in a cohort of African children with renal tumours Accepted: 22 November 2005 / Published online: 19 January 2006 Ó Springer-Verlag 2006 Abstract Hypertension is a frequent problem in children with renal tumour, yet there are few reports from centres in the third world. A retrospective study of blood pres- sure in a cohort of 46 patients with renal tumours seen over a 3-year period was carried out. Fifty percent of patients presenting with Wilms’ tumour were hyperten- sive. Serum concentrations of active renin correlated poorly with blood pressure. There was no correlation between serum concentrations of active renin and tumour mass or histology. Specific antihypertensive therapy was offered to 11 patients who had either neurological or cardiac complications of hypertension. All other patients with Wilms’ tumour had their blood pressure controlled by neoadjuvant chemotherapy. Patients with mesoblastic nephroma were managed by primary surgery. Patients with asymptomatic hypertension may be monitored as hypertension will resolve with neoadjuvant chemother- apy. Those with compelling symptomatology will require additional hypertensive medication. Keywords Wilms’ tumour Æ Mesoblastic nephroma Æ Renin Æ Hypertension Æ Antihypertensive treatment Introduction Hypertension is a frequent problem in children with renal tumours and has been ascribed to increased renin production either as a tumour metabolite or secondary to alteration of intra-renal blood flow and stimulation of the juxta-glomerular apparatus [1–3]. The reported incidence in cohorts of patients with Wilms’ tumour varies widely from 25 to 100% [1, 3–5]. The incidence in the developing world is unknown. As patients in this environment often present late with large tumours [6], hypertension is a potential problem. However, hyper- tension is a difficult diagnosis in childhood and may have been under-reported particularly from centres in Africa where more pressing co-morbidity amongst pa- tients with renal tumours demands attention [7]. Hypertension and hyper-reninaemia have been reported in association with tumours unrelated to the kidney; e.g. hepatoblastoma [8] and ovarian tumour [9], strongly suggesting that at least in some patients hyper-renina- emia is a true paraneoplastic effect rather than reno- vascular in origin. Hypertension is not a benign entity and is of itself responsible for major morbidity and some mortality [10– 13]. We have reviewed our experience over the last 3 years in order to define the incidence of hypertension in our patients and to refine its management. Patients and methods All children presenting to the Paediatric Surgical Service at Inkosi Albert Luthuli Central Hospital, Durban, for management of a renal tumour were identified from the Departmental database and included in the study. Ap- proval for the study was given by the University of KwaZulu-Natal Biomedical Ethics Committee. If the blood pressure (BP) was elevated at the time of admission to hospital, the serum renin concentration was estimated as part of the initial work-up. Repeated BP measurements were made thereafter. Hypertension was defined as a sustained rise in the systolic pressure above the 95th percentile for height and age using norms derived from American children [14]. The mean arterial G.P. Hadley (&) Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Private Bag 7, 4013 Durban, South Africa E-mail: hadley@ukzn.ac.za Tel.: +27-31-2401579 Fax: +27-31-2401667 M. Mars Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa Pediatr Surg Int (2006) 22: 219–223 DOI 10.1007/s00383-005-1626-z