Onohara Tadashi, Takagi Toshio, Yoshida Kazuhiko, Iizuka Junpei, Okumi Masayoshi, Kondo Tsunenori, Ishida Hideki, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
Int J Urol. 2019 Feb;26(2):229-233. doi: 10.1111/iju.13844. Epub 2018 Nov 1.
To investigate kidney function change during adrenalectomy in patients with primary aldosteronism and assess predictors of kidney function decline.
The present study included 90 patients who underwent adrenalectomy for primary aldosteronism between 2004 and 2017. Kidney function was evaluated 1 month after surgery. Predictors associated with a ≥10% decline in the estimated glomerular filtration rate were investigated. Kidney parenchymal volume was compared before and after surgery in 10 patients using volumetric studies.
The mean estimated glomerular filtration rate decline in the total cohort at 1 month after surgery was 13.3% (before: 72.9 mL/min/1.73 m , after: 64.9 mL/min/1.73 m , P < 0.0001). The mean serum plasma aldosterone concentration (before: 373 pg/mL vs after: 78 pg/mL, P < 0.0001) and potassium level (before: 3.7 mEq/L vs after: 3.9 mEq/L, P = 0.0001) were also significantly different after surgery. Age (odds ratio 6.37, P = 0.0006), preoperative plasma aldosterone concentration (odds ratio 3.12, P = 0.0209) and preoperative serum potassium level (odds ratio 2.87, P = 0.0010) were independent predictors of a ≥10% decline in estimated glomerular filtration rate. Volumetric studies in 10 patients showed that mean postoperative parenchymal volume was significantly decreased compared with the preoperative volume (263 cc vs 312 cc, P = 0.0003), with decreases in estimated glomerular filtration rate from 63 to 56 mL/min/1.73 m (P = 0.0146).
Kidney function deterioration after adrenalectomy can be detected in patients with primary aldosteronism. Age, preoperative plasma aldosterone concentration and preoperative potassium level are significant predictors of a decrease in the estimated glomerular filtration rate. Normal parenchymal volume decreases in line with renal functional deterioration.
研究原发性醛固酮增多症患者肾上腺切除术中肾功能的变化，并评估肾功能下降的预测因素。
本研究纳入了2004年至2017年间因原发性醛固酮增多症接受肾上腺切除术的90例患者。术后1个月评估肾功能。研究与估计肾小球滤过率下降≥10%相关的预测因素。对10例患者进行容积研究，比较手术前后的肾实质体积。
术后1个月时，整个队列的平均估计肾小球滤过率下降了13.3%（术前：72.9 mL/min/1.73m²，术后：64.9 mL/min/1.73m²，P < 0.0001）。术后平均血清醛固酮浓度（术前：373 pg/mL，术后：78 pg/mL，P < 0.0001）和血钾水平（术前：3.7 mEq/L，术后：3.9 mEq/L，P = 0.0001）也有显著差异。年龄（比值比6.37，P = 0.0006）、术前血浆醛固酮浓度（比值比3.12，P = 0.0209）和术前血钾水平（比值比2.87，P = 0.0010）是估计肾小球滤过率下降≥10%的独立预测因素。10例患者的容积研究显示，术后平均实质体积较术前显著减少（263 cc对312 cc，P = 0.0003），估计肾小球滤过率从63降至56 mL/min/1.73m²（P = 0.0146）。
原发性醛固酮增多症患者肾上腺切除术后可检测到肾功能恶化。年龄、术前血浆醛固酮浓度和术前血钾水平是估计肾小球滤过率下降的重要预测因素。正常实质体积随肾功能恶化而减小。
