Long-term Renal Outcomes in Patients With Primary Aldosteronism

Sechi, Leonardo A.; Novello, Marileda; Lapenna, Roberta; Baroselli, Sara; Nadalini, Elisa; Colussi, GianLuca; Catena, Cristiana

doi:10.1001/jama.295.22.2638

Cited by 354 publications

(325 citation statements)

References 42 publications

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“…Although mineralocorticoid receptor antagonists produced multi-directional anti-inflammatory effects, their monocyte-and lymphocyte-suppressive effects did not increase with time, and cytokine release was higher than in control subjects during the entire observation period. These findings are in disagreement with those of other authors [8][9][10] who observed similar cardiovascular and nephroprotective benefits after adrenalectomy and spironolactone treatment. However, their study populations included both patients with aldosteronoma (most of whom underwent adrenalectomy) and patients with bilateral adrenal hyperplasia (treated with spironolactone), and this fact may explain the differences between our results and their results.…”

contrasting

confidence: 99%

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

Krysiak

2011

Hypertens Res

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contrasting

confidence: 99%

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

Krysiak

2011

Hypertens Res

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“…6 The excess of aldosterone might be associated with remodeling of the left ventricle and higher albumin excretion. 7,8 Indeed, as we have shown recently, patients with PA have an increased intima-media thickness of the carotid artery and higher aortic stiffness compared with EH. 9,10 Aldosterone concentrations are elevated in obese and MS patients, 11 there is an increasing body of evidence linking elevated plasma aldosterone levels to MS and its components.…”

Section: Introductionmentioning

confidence: 77%

The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

et al. 2010

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Metabolic syndrome (MS) is frequent clinical condition in patients with hypertension. Primary aldosteronism (PA) is a common form of secondary hypertension. This study was aimed at investigating the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone overproduction because of idiopathic hyperaldosteronism (IHA). The diagnosis of the particular form of PA was based on adrenal venous sampling and/or successful surgery confirmed by histopathological examination. We analyzed clinical and laboratory data from 100 patients with PA (50 patients with IHA and 50 patients with APA) and from 90 patients with essential hypertension (EH). Metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of PA (APA). The prevalence of the MS (62% in IHA, 34% in APA and 56% in EH), the body mass index value (30 ± 4 kg m -2 in IHA, 27±5 kg m -2 in APA and 29±5 kg m -2 in EH) and triglycerides levels (1.9±0.9 mmol l -1 in IHA,1.4± 0.8 mmol l -1 in APA and 2.01 ± 1.39 mmol l -1 in EH) were all significantly (Po0.05) higher in IHA compared with APA patients. Metabolic profile of patients with bilateral form of PA (because of IHA) is similar to EH in contrast to unilateral form of PA (APA).

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“…Recruitment of patients, criteria that were used for diagnosis, methods that were used to assess renal function, and follow-up have been described in detail in previous publications (20,21). All patients were referred to the Hypertension Clinic of our university for evaluation of their hypertensive state.…”

Section: Patientsmentioning

confidence: 99%

“…Throughout this article, GFR and albuminuria refer, respectively, to the mean of two separate measurements of 24-h creatinine clearance and urinary albumin excretion expressed as the log-transformed urine albumin-to-creatinine ratio. Albuminuria was normalized for urinary creatinine because previous studies consistently demonstrated glomerular hyperfiltration in patients with primary aldosteronism (19,20,31). Plasma active renin and plasma aldosterone concentrations were measured by RIA according to current guidelines (32) in plasma samples that were obtained with patients in the sitting position.…”

Section: Renal Function Treatment and Follow-upmentioning

confidence: 99%

“…With respect to the kidney, animal studies support the role of aldosterone in the progression of renal vascular disease (10 -13), but the clinical evidence of the contribution of this hormone to renal dysfunction is limited (14 -16). In fact, the majority of initial reports indicated that primary aldosteronism is less likely to cause overt renal damage (6,7,17,18), and two recent studies with short-term (19) and long-term (20) follow-up consistently demonstrated that the renal dysfunction of primary aldosteronism is closely related with the hemodynamic adaptation of the kidney to the effect of aldosterone excess.…”

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confidence: 99%

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Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Catena¹,

Colussi²,

Nadalini³

et al. 2007

Clinical Journal of the American Society of Nephrology

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102

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Background: The renal damage that is present in primary aldosteronism might reflect functional and potentially reversible abnormalities that are initiated by glomerular hyperfiltration. The aim of this study was to investigate the relationships of plasma renin and aldosterone concentrations with renal outcomes after treatment of primary aldosteronism.Design, setting, participants, and measurements: Fifty-six consecutive patients who had primary aldosteronism and were recruited in a university center were studied. Patients were prospectively followed after either surgical or medical treatment for a mean of 6.2 yr, during which they received antihypertensive drugs to reach a target BP of <140/90 mmHg.Results: At baseline, patients with primary aldosteronism had higher creatinine clearance and albuminuria than 323 patients with essential hypertension and 113 normotensive individuals. In patients with primary aldosteronism, plasma active renin levels that were higher than the lower limit of detection (2.5 pg/ml) were associated with higher BP, plasma potassium, and albuminuria and lower creatinine clearance. Plasma aldosterone concentrations that were higher than the median value (225 pg/ml) were associated with lower plasma potassium and higher creatinine clearance. Creatinine clearance was correlated directly with plasma aldosterone and inversely with renin. During follow-up, patients with higher baseline plasma renin required use of more antihypertensive drugs to obtain BP control and had a smaller early decline in albuminuria than did patients with suppressed renin.Conclusions: Escape of renin from suppression by excess aldosterone is associated with evidence of more severe renal damage in patients with primary aldosteronism and predicts less favorable outcomes after treatment.

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Long-term Renal Outcomes in Patients With Primary Aldosteronism

Abstract: In the majority of patients in this study, primary aldosteronism was characterized by partially reversible renal dysfunction in which elevated albuminuria is a marker of a dynamic rather than structural renal defect.

Cited by 354 publications

References 42 publications

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

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