Chronic kidney disease score for predicting postoperative masked renal insufficiency in patients with primary aldosteronism

Tanase-Nakao, Kanako; Naruse, Mitsuhide; Nanba, Kazutaka; Tsuiki, Mika; Tagami, Tetsuya; Usui, Takeshi; Okuno, Hiroshi G.; Shimatsu, Akira; Hashimoto, Shigeatsu; Katabami, Takuyuki; Ogo, Atsushi; Okumura, Atsuko; Umakoshi, Hironobu

doi:10.1111/cen.12497

Cited by 19 publications

(27 citation statements)

References 24 publications

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“…40 They are most marked in patients with unilateral PA 41,42 and are reversed within one month of adrenalectomy (Figure 1). 40,[43][44][45][46][47][48][49][50][51][52][53][54][55] Hemodynamic stress and hyperaldosteronism per se lead to chronic structural damage in the long run. 45,56 PA patients have been reported to display a certain level of insulin resistance, which may improve after adrenalectomy.…”

Section: Outcomes Of Adrenalectomy In Unilateral Pamentioning

confidence: 99%

“…36,37 The relative glomerular hyperfiltration and microalbuminuria of PA patients are corrected on specific drugs (Figure 1). 40,[44][45][46]50,51,[53][54][55] Spironolactone was found to be less effective than surgery for achieving this end in one study using a fixed low dose (50 mg/day). 50 Five other studies, with spironolactone uptitrated as needed and tolerated, revealed effects no different from those of surgery.…”

Section: Outcomes Of Drug-based Treatmentmentioning

confidence: 99%

“…Mineralocorticoid receptor antagonist treatment and potassium supplements should be discontinued immediately after surgery and serum potassium concentrations should be monitored closely. 25  Adrenalectomy also unmasks postoperative eGFR below 60 ml/min/1.73m² in 30% to 40% of patients with unilateral PA. 52,54,55 It is more likely in patients who have a preoperative eGFR that is already close to this threshold. 54 Drug-based treatment  The pharmacokinetics of spironolactone and eplerenone are unaffected in patients with CKD.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…25  Adrenalectomy also unmasks postoperative eGFR below 60 ml/min/1.73m² in 30% to 40% of patients with unilateral PA. 52,54,55 It is more likely in patients who have a preoperative eGFR that is already close to this threshold. 54 Drug-based treatment  The pharmacokinetics of spironolactone and eplerenone are unaffected in patients with CKD. 100 Amiloride is partly excreted in the urine and its half-life is longer in patients with CKD, so lower doses and once-daily intakes can be used.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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Section: Outcomes Of Adrenalectomy In Unilateral Pamentioning

confidence: 99%

Section: Outcomes Of Drug-based Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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“…However, those symptoms do not always occur, which makes early discovery difficult (3). Adrenalectomy is widely performed to treat adrenal tumors; however, there is increasing focus on attenuating the progression of renal dysfunction following adrenalectomy to treat PA (3)(4)(5), the mechanism of which has not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Kidney dysfunction following adrenalectomy in autosomal dominant polycystic kidney disease complicated with primary aldosteronism: A case report

Hikita

Kanno

Watanabe

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study reported a case of autosomal dominant polycystic kidney disease complicated with primary aldosteronism in a 49-year-old woman. The patient was referred for refractory hypertension. Laboratory examinations revealed low potassium and renin levels. Computed tomography indicated a right adrenal tumor and multiple renal cysts. Adrenal vein sampling revealed a high aldosterone level on the side of the tumor. The patient was diagnosed with autosomal dominant polycystic kidney disease complicated by primary aldosteronism and adrenalectomy was performed. Over the following 7 months, the estimated glomerular filtration rate decreased from 76 to 48 ml/min/1.73 m 2 , which was attributed to glomerular hyperfiltration correction induced by hyperaldosteronism remission, indicating kidney dysfunction. Clinicians must therefore monitor for the unmasking of kidney dysfunction following adrenalectomy in such cases. IntroductionAutosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease with a poor renal outcome. Pathogenesis involves cyst formation and growth, which leads to an increase in kidney volume and a decline in glomerular filtration rate (1). Approximately 50% of ADPKD patients finally need renal replacement therapy (1). In addition, ADPKD is sometimes complicated with hypertension (1).Epidemiologically, recent prevalence of ADPKD in Japan remains unclear. However, Higashihara et al (2) reported a prevalence of ADPKD of 117 in 1,000,000 in Japan at the end of 1994. In Western countries, ADPKD affects both sexes and all ethnicities, with an estimated frequency of between 1 in 400 to 1 in 1,000 live births (1).Primary aldosteronism (PA) is an endocrine disease that causes secondary hypertension and increases the risk of cardiovascular disease. Among cases of hypertension, Utsumi et al (3) reported that 6-11% are secondary to PA, although prevalence varies worldwide. The pathogenesis of PA is excess secretion of aldosterone from bilateral or unilateral adrenal gland or tumors (3). The early discovery and treatment of PA is a crucial clinical issue to prevent progression of atherosclerosis. The classical symptoms of PA are refractory hypertension and hypokalemia. However, those symptoms do not always occur, which makes early discovery difficult (3). Adrenalectomy is widely performed to treat adrenal tumors; however, there is increasing focus on attenuating the progression of renal dysfunction following adrenalectomy to treat PA (3-5), the mechanism of which has not been fully elucidated.The primary aims of treating ADPKD and PA are controlling hypertension and preserving kidney function. However, only a few cases of the two diseases occurring together have been reported (6,7). These reports have focused on diagnosing these disorders, however to the best of our knowledge, the effect of adrenalectomy on renal function in patients with ADPKD and PA has not been fully elucidated.The present report documents the case of a patient with ADPKD who experienced a decline in estimated...

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Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism

et al. 2017

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Chronic kidney disease score for predicting postoperative masked renal insufficiency in patients with primary aldosteronism

Abstract: The pre-operative eGFR and ARR were the significant contributing factors for postoperative CKD in PA. By combining these independent factors, we created a CKD score which provides useful information before surgery about the risk for development of postoperative CKD.

Cited by 19 publications

References 24 publications

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Kidney dysfunction following adrenalectomy in autosomal dominant polycystic kidney disease complicated with primary aldosteronism: A case report

Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism

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