Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan

Yoshioka, Masayuki; Nakajima, Yasuyo; Miyamoto, T.; Igarashi, Takamichi; Sakamaki, Koji; Akuzawa, Masako; Ishida, Emi; Horiguchi, Kazuhiko; Yamada, Eijiro; Saito, Tsugumichi; Ozawa, Atsushi; Shimomura, Y; Kobayashi, Isao; Andou, Yoshitaka; Shirabe, Ken; Yamada, Masanobu

doi:10.1210/js.2018-00260

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…Left renal vein or inferior vena cava were identified, respectively. The main adrenal vein was ligated using a bipolar advanced haemostatic instrument, a deterioration of renal function has been reported (when an aldosterone-producing adenoma was identified) [16][17][18]. According to our knowledge, the impact of laparoscopic adrenalectomy on renal function has not yet been studied in a prospective randomised trial.…”

Section: Interventionsmentioning

confidence: 99%

“…Earlier studies on renal function concentrated exclusively on patients with primary hyperaldosteronism, who underwent unilateral laparoscopic adrenalectomy [16][17][18]. The main factors predicting impaired kidney function postoperatively were preoperative eGFR ≤ 102 ml/min/1.73 m 2 and aldosterone to renin ratio ≥ 448 ng/dl:ng/ml/h [29].…”

Section: Original Papermentioning

confidence: 99%

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The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

Kozłowski

Myśliwiec

Choromańska

et al. 2019

Endokrynologia Polska

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Introduction: Laparoscopic adrenalectomy is the gold standard management of benign adrenal masses and isolated metastases to adrenal glands. Two techniques of endoscopic adrenalectomy: lateral transperitoneal approach (LTA) and posterior retroperitoneal approach (PRA) seem to be equally safe and effective. Recent studies suggest advantages of PRA over LTA in terms of lower intensity of postoperative pain, shorter hospital stay, faster recovery, and lower early morbidity. However, PRA involves high insufflation pressure of CO 2 within a limited retroperitoneal space. The aim of our study was to prospectively assess the effect of LTA versus PRA laparoscopic adrenalectomies on renal function. Material and methods: We randomly assigned patients referred for unilateral adrenalectomy to either LTA (n = 33) or PRA (n = 44). The inclusion criteria were: hormonal activity and/or tumour diameter > 4 cm and/or suspicion of metastasis to adrenal gland. The exclusion criteria comprised: tumours > 8 cm, results of imaging studies suggesting primary invasive malignancy, and refusal to undergo randomisation. The patients were prospectively followed for a minimum of six months. Serum creatinine, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively and at postoperative days: 1, 7, and 30. Results: We found increased concentrations of urinary NGAL at day 1 following laparoscopic adrenalectomy using PRA, as compared to LTA. Patients undergoing right-sided PRA had increased creatinine concentrations, as compared to left-sided PRA. Patients with aldosterone-producing adenoma had decreased preoperative eGFR as compared to subjects with non-functioning incidentaloma. NGAL increased significantly in this group postoperatively. All the disturbances normalised within one month postoperatively. Conclusions: Renal function impairment after PRA may result from compression of inferior vena cava by high retroperitoneal pressure during right-sided adrenalectomy. Despite the transient character of the observed abnormalities, we suggest that patients with high risk of acute kidney injury may benefit from an alternative technique of adrenalectomy using LTA.

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Section: Interventionsmentioning

confidence: 99%

Section: Original Papermentioning

confidence: 99%

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

Kozłowski

Myśliwiec

Choromańska

et al. 2019

Endokrynologia Polska

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Emerging association between KCNJ5 mutations and vascular failure in primary aldosteronism

Jojima,

Tanaka,

Node

2023

Hypertens Res

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Chronological outcomes of renal function after adrenalectomy in patients with primary aldosteronism across age groups

Ma,

Tang,

et al. 2024

Front. Endocrinol.

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BackgroundPatients with primary aldosteronism present with renal function decline after unilateral adrenalectomies. Our study aimed to assess the evolution of renal function after adrenalectomy in patients with primary aldosteronism across different age groups and to identify risk factors for postoperative renal function deterioration.MethodsWe included 210 patients with primary aldosteronism categorized into three age groups: <40, 40–60, and ≥60 years old. We followed up the patients for 1 month, 1 year, and 5 years after adrenalectomy to assess outcomes. Multivariate analyses were performed to identify predictors of renal function deterioration, and a univariate logistic regression analysis was used to assess the relationship between KCNJ5 mutation status and the decline in renal function.ResultsPatients aged <40 years had a shorter duration of hypertension, higher preoperative diastolic blood pressure, and higher preoperative estimated glomerular filtration rate (eGFR) than did those in the other age groups. This group also exhibited the highest rate of complete clinical success, although there were no significant differences in complete biochemical success among age groups. Renal function declined in all three groups after adrenalectomy. However, changes in blood pressure and eGFR in the short- or long-term after adrenalectomy showed no significant differences among the three groups. Hypertension duration, preoperative systolic blood pressure (SBP), and plasma aldosterone concentration (PAC) were predictors of postoperative renal function deterioration. KCNJ5 wild-type status was significantly correlated with the occurrence of chronic kidney disease after adrenalectomy.ConclusionsUnilateral adrenalectomy demonstrates favorable biochemical and clinical outcomes in patients with primary aldosteronism, irrespective of age. Long-term eGFR decline is similar among the different age groups. KCNJ5 mutation exhibits a protective effect against the risk of chronic kidney disease after unilateral adrenalectomy.

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Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan

Cited by 4 publications

References 42 publications

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

Emerging association between KCNJ5 mutations and vascular failure in primary aldosteronism

Chronological outcomes of renal function after adrenalectomy in patients with primary aldosteronism across age groups

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