Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Clin Chim Acta. 2011 Jul 15;412(15-16):1319-25. doi: 10.1016/j.cca.2011.02.018. Epub 2011 Feb 21.
Kidney impairment is noted in primary aldosteronism (PA), and probably initiated by glomerular hyperfiltration.
A prospectively defined survey was conducted on 602 patients who were suspected of PA in the multiple-center Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Estimated glomerular filtration rate (eGFR) was calculated and followed up at 1 yr after treatment.
The diagnosis of PA was confirmed in 330 patients. Among them 17% of these patients had kidney impairment (eGFR<60 ml/min/1.73 m²). Patients with PA had a higher prevalence of estimated hyperfiltration than those with essential hypertension (EH) (14.5% vs. 7.0%, p=0.005). The eGFR independently predicted PA (OR, 1.017) in the propensity-adjusted multivariate logistic model. In PA, plasma renin activity and lower serum potassium (p=0.018) was correlated with kidney impairment (p=0.001), while this relationship was not significant in patients with EH. Either unilateral adrenalectomy or treatment of spironolactone for PA patients caused a decrease of eGFR (p<0.001). Pre-operative hypokalemia (p=0.013) and the long latency of hypertension (p=0.016) could enhance the significant decrease of eGFR after adrenalectomy.
Patients with aldosteronism had relative estimated hyperfiltration than patients with EH. Calculation of eGFR may increase the specificity in identifying patients with PA. Our findings demonstrate the correlation of serum potassium and renin with estimated hyperfiltration in PA and their relationship to kidney damage. These results provide a high priority for future renal protective strategies and methods for the early diagnosis and prompt treatment of PA.
醛固酮增多症（PA）患者存在肾功能损害，可能由肾小球高滤过引起。
在多中心台湾原发性醛固酮增多症调查（TAIPAI）数据库中，对 602 例疑似 PA 的患者进行了前瞻性定义调查。计算估计肾小球滤过率（eGFR），并在治疗后 1 年进行随访。
在 330 例确诊为 PA 的患者中，有 17%的患者存在肾功能损害（eGFR<60 ml/min/1.73 m²）。与原发性高血压（EH）患者相比，PA 患者的估计高滤过发生率更高（14.5% vs. 7.0%，p=0.005）。在倾向评分调整后的多变量逻辑模型中，eGFR 独立预测 PA（OR，1.017）。在 PA 患者中，血浆肾素活性和较低的血清钾（p=0.018）与肾功能损害相关（p=0.001），而在 EH 患者中这种关系不显著。单侧肾上腺切除术或螺内酯治疗 PA 患者均导致 eGFR 降低（p<0.001）。术前低钾血症（p=0.013）和高血压潜伏期长（p=0.016）可增强肾上腺切除术后 eGFR 的显著降低。
与 EH 患者相比，醛固酮增多症患者存在相对估计高滤过。计算 eGFR 可能会提高识别 PA 患者的特异性。我们的研究结果表明，血清钾和肾素与 PA 中的估计高滤过相关，并且与肾脏损害相关。这些结果为未来的肾脏保护策略以及早期诊断和及时治疗 PA 提供了重要的依据。
