Document Detail

Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment.
MedLine Citation:
PMID:  21738054     Owner:  NLM     Status:  Publisher    
OBJECTIVES: To obtain information about the effect of prolonged aldosterone excess on kidney function. METHODS: We determined kidney function changes defined by cystatin C-based estimations of glomerular filtration rate (CysC-GFR). Pretreatment proteinuria and intrarenal Doppler velocimetric indices in primary aldosteronism were examined and followed after adrenalectomy or spironolactone treatment. RESULTS: This prospective, multicenter study included 130 primary aldosteronism patients (56 men; age, 49.9 ± 13.4 years: 100 with adenoma and 30 with idiopathic hyperaldosteronism) and 73 essential hypertension patients (36 men; age, 51.4 ± 14.8 years) as controls. Patients with primary aldosteronism had higher CysC-GFR (P < 0.05) and heavier proteinuria (0.042) than those with essential hypertension. With primary aldosteronism, a higher aldosterone-renin ratio (odds ratio, OR = 7.85, P = 0.008) was independently related to pretreatment CysC-GFR. The factors related to pretreatment proteinuria included CysC-GFR (OR, -0.006, P = 0.001), plasma aldosterone concentration (OR, 0.004, P = 0.002), and duration of hypertension (OR, 0.016, P = 0.032). Duration of hypertension was also independently correlated with the pretreatment resistive index among primary aldosteronism patients (OR, 0.004, P = 0.035). CysC-GFR (all, P < 0.05), proteinuria (P < 0.001), and resistive index (P < 0.001) decreased 1 year after adrenalectomy but not with spironolactone treatment. CONCLUSION: Our data suggest that prolonged hyperaldosteronism will cause relative kidney hyperfiltration and reversible intrarenal vascular structural changes, which disguise the consequent renal injury, including declining GFR and proteinuria. Adrenalectomy and spironolactone treatment exert different clinical impacts toward kidney damage even with a similar blood pressure-lowering effect.
Vin-Cent Wu; Chin-Chi Kuo; Shuo-Meng Wang; Kao-Lang Liu; Kuo-How Huang; Yen-Hung Lin; Tzong-Shinn Chu; Hung-Wei Chang; Chien-Yu Lin; Chia-Ti Tsai; Lian-Yu Lin; Shih-Chieh Chueh; Tze-Wah Kao; Yung-Ming Chen; Wen-Chih Chiang; Tun-Jun Tsai; Yi-Luwn Ho; Shuei-Liong Lin; Wei-Jei Wang; Kwan-Dun Wu;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-6
Journal Detail:
Title:  Journal of hypertension     Volume:  -     ISSN:  1473-5598     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aDepartment of Internal Medicine bDepartment of Yun-Lin Branch cDepartment of Urology dDepartment of Medical Image, National Taiwan University Hospital eDepartment of Internal Medicine, En- Chu- Kong Hospital, Taipei County, Taipei, Taiwan fCleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, USA gDepartment of Internal Medicine, Tao-Yuan General Hospital, Tao-Yuan, Taiwan.
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