Suspected primary hyperreninism in a cat with malignant renal sarcoma and global renin-angiotensin-aldosterone system upregulation

Abstract

A 14-year-old male castrated domestic medium-hair cat with diabetes mellitus was evaluated for vomiting, diarrhea, and anorexia. Two weeks before presentation, the cat had been diagnosed with congestive heart failure and started on furosemide. Initial diagnostic testing identified hypokalemia, systemic hypertension, and hypertrophic cardiomyopathy phenotype, and plasma aldosterone concentration was moderately increased. Abdominal ultrasound examination disclosed bilateral adrenomegaly and a right renal mass, and cytology of a needle aspirate of the mass was consistent with malignant neoplasia. The cat was treated with amlodipine and spironolactone. Because of the unusual presentation for hyperaldosteronism, a comprehensive profile of renin-angiotensin-aldosterone system (RAAS) peptides was performed. Results from multiple timepoints indicated persistently and markedly increased plasma renin activity and generalized RAAS upregulation. In addition to the lack of adrenal tumor, the markedly increased plasma renin activity was atypical for primary hyperaldosteronism. These clinical findings are suggestive of primary hyperreninism, a condition previously unreported in cats. The concurrent presence of a renal neoplasm suggests the possibility of a renin-secreting tumor.

Keywords: chronic kidney disease; endocrinopathy; hyperaldosteronism; hypertension; reninoma.

FIGURE 1

The patient's right renal mass (A, B). On abdominal ultrasound, a heterogenous mass was identified at the caudal pole of the right kidney (white circle)

FIGURE 2

Cytology of a fine‐needle aspirate of the cat's renal mass (Wright's stain, ×60 magnification). Cells displayed atypia with anisokaryosis, prominent nucleoli, and nuclear molding. Cytology was consistent with a malignant neoplasia with a sarcoma considered most likely. Scale bar = 20 μm