Yoshioka Masayuki, Nakajima Yasuyo, Miyamoto Tomoko, Igarashi Takamichi, Sakamaki Koji, Akuzawa Masako, Ishida Emi, Horiguchi Kazuhiko, Yamada Eijiro, Saito Tsugumichi, Ozawa Atsushi, Shimomura Younosuke, Kobayashi Isao, Andou Yoshitaka, Shirabe Ken, Yamada Masanobu
Department of Internal Medicine, Division of Endocrinology and Metabolism, Gunma University Graduate School of Medicine, Maebashi, Japan.
Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
J Endocr Soc. 2018 Dec 17;3(3):577-589. doi: 10.1210/js.2018-00260. eCollection 2019 Mar 1.
In patients with aldosterone-producing adenomas (APAs), adrenalectomy causes a rapid decrease in blood pressure and increase in blood potassium levels; however, the effects of these intensive metabolic changes on kidney function with age have not yet been examined in Japan.
To investigate factors related to the progression of kidney dysfunction after adrenalectomy in different age groups.
Fifty Japanese patients with APAs and 27,572 health checkup patients as controls were examined.
We investigated changes in estimated glomerular filtration rate (eGFR) after adrenalectomy and characterized patients who progressed to chronic kidney disease (CKD).
The postoperative cutoff age of CKD is 50 years and age is a unique factor for the progression of CKD after adrenalectomy. Among preoperative patients, CKD was 6% for those <50 years old and 40% for those ≥50 years old, indicating a higher prevalence of CKD with APAs than in control subjects. Median eGFR <50 mL/min/1.73 m did not significantly change after adrenalectomy but decreased from 67 to 42 mL/min/1.73 m in those with APAs ≥50 years old. Patients with APAs ≥50 years old who progressed to CKD showed higher preoperative aldosterone/renin ratios, lower potassium and chloride levels, lower body mass index, and a higher incidence of a history of cardiovascular events and KCNJ5 mutation rates.
Age is the most important predictor of the progression of kidney dysfunction after adrenalectomy in Japanese patients with APAs, particularly those with a history of cardiovascular events and positivity for KCNJ5 mutations.
在原发性醛固酮增多症腺瘤（APA）患者中，肾上腺切除术可导致血压迅速下降和血钾水平升高；然而，在日本，这些剧烈代谢变化对肾功能随年龄增长的影响尚未得到研究。
探讨不同年龄组肾上腺切除术后肾功能不全进展的相关因素。
对50例日本APA患者和27572例健康体检患者作为对照进行了检查。
我们研究了肾上腺切除术后估计肾小球滤过率（eGFR）的变化，并对进展为慢性肾脏病（CKD）的患者进行了特征分析。
CKD的术后临界年龄为50岁，年龄是肾上腺切除术后CKD进展的唯一因素。在术前患者中，<50岁者CKD患病率为6%，≥50岁者为40%，表明APA患者的CKD患病率高于对照组。肾上腺切除术后，eGFR中位数<50 mL/min/1.73 m²无显著变化，但≥50岁的APA患者从67降至42 mL/min/1.73 m²。进展为CKD的≥50岁的APA患者术前醛固酮/肾素比值更高、血钾和血氯水平更低、体重指数更低，心血管事件病史和KCNJ5突变率的发生率更高。
年龄是日本APA患者肾上腺切除术后肾功能不全进展的最重要预测因素，尤其是那些有心血管事件病史和KCNJ5突变阳性的患者。
