A case of hyperreninemic hypertension with bilateral positive captopril renography but without renovascular stenosis.

A 34-year-old woman was admitted to our hospital because of hypertension with hypokalemia. Her past medical history revealed that at age 24 she had been diagnosed with left renal lithiasis and had undergone extracorporeal shock-wave lithotripsy (ESWL). Physical examination showed that her peripheral pulses were intact and no peripheral edema or audible bruits were detected. Her serum potassium concentration was 2.7 mEq/mL, her plasma aldosterone concentration (PAC) was 96.7 ng/dL, and her plasma renin activity (PRA) was 28.1 ng/mL/h. Intrarenal lobar artery flow pattern assessed by Doppler ultrasound showed no abnormality. A renogram demonstrated a normal symmetrical tracing pattern. However, administration of 50 mg captopril induced delayed transit of tracer in both kidneys. Selective angiographic studies showed no stenotic lesions in the proximal to distal renal arteries. Blood sampling from each renal vein showed no laterality of PRA. While the possibility of the Page kidney phenomenon resulting from ESWL could not be excluded completely, the patient was diagnosed as a very rare case of hyperreninemic essential hypertension with positive captopril renography in both kidneys.