Intrarenal Hemodynamics in Primary Aldosteronism before and after Treatment

Sechi, Leonardo A.; Fabio, A. Di; Bazzocchi, Massimo; Uzzau, Alessandro; Catena, Cristiana

doi:10.1210/jc.2008-2245

Cited by 116 publications

(93 citation statements)

References 40 publications

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“…Previous studies have investigated this renal hyperfiltration with more accurate methods such as 24-h-creatinine clearance and radioisotopic clearance (10,11). The observed glomerular hyperfiltration is associated with decreased intrarenal vascular resistance as assessed by duplex Doppler sonography (39). In a study by Catena et al (40), the initial GFR and the decline in GFR after treatment were significantly lower in patients with a low pretreatment plasma aldosterone (!225 pg/ml).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce. Design and methods: This prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; nZ86); spironolactone (nZ65); and eplerenone (nZ18)). Results: GFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications. Conclusions: Renal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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“…We have already mentioned the effects of spironolactone on correction of albuminuria. These effects are at least in part related to reversal of an intrarenal hemodynamic adaptation to aldosterone excess with a vasodilatory response that has been demonstrated with intrarenal echo-Doppler examination (Sechi et al, 2009). …”

Section: Primary Aldosteronismmentioning

confidence: 94%

Potassium-Sparing Diuretics in Hypertension

Catena¹,

Colussi²,

Sechi³

2012

Antihypertensive Drugs

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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%

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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Intrarenal Hemodynamics in Primary Aldosteronism before and after Treatment

Abstract: In primary aldosteronism, sonographic evidence of decreased intrarenal vascular resistance is associated with glomerular hyperfiltration. Both adrenalectomy and spironolactone revert the intrarenal hemodynamic pattern and decrease urinary protein losses.

Cited by 116 publications

References 40 publications

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Potassium-Sparing Diuretics in Hypertension

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

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