Lee Jee Young, Kim Hyoungnae, Kim Hyung Woo, Ryu Geun Woo, Nam Yooju, Lee Seonyeong, Joo Young Su, Lee Sangmi, Park Jung Tak, Han Seung Hyeok, Kang Shin-Wook, Yoo Tae-Hyun, Yun Hae-Ryong
Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea.
Division of Nephrology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
Electrolyte Blood Press. 2019 Dec;17(2):45-53. doi: 10.5049/EBP.2019.17.2.45. Epub 2019 Dec 31.
Aldosterone-induced glomerular hyperfiltration can lead to masked preoperative renal dysfunction in primary aldosteronism(PA) patients. We evaluated whether PA patients had a higher prevalence of acute kidney injury (AKI) after unilateral adrenalectomy. In addition, we identified risk factors for AKI in these subjects.
This retrospective study included 107 PA patients, and 186 pheochromocytoma patients as a control group, all of whom underwent adrenalectomy between January 2006 and November 2017 at Yonsei University Severance Hospital. The primary outcome was AKI within 48 hours after adrenalectomy. Univariate and multivariate logistic regression analyses were performed to identify predictors of AKI after adrenalectomy.
Overall incidence of AKI was 49/293 (16.7%). In PA patients, the incidence of AKI was 29/107 (27.1%). In contrast, incidence of AKI was 20/186 (10.7%) in pheochromocytoma patients. Univariate and multivariate logistic regression analysis both showed a higher risk of postoperative AKI in PA patients compared to pheochromocytoma patients. In addition, old age, diabetes, longer duration of hypertension, lower preoperative estimated glomerular filtration rate, high aldosterone-cortisol ratio (ACR) and lateralization index (LI) were identified as independent risk factors for postoperative AKI in PA patients after unilateral adrenalectomy.
Incidence and risk of postoperative AKI were significantly higher in PA patients after surgical treatment. High ACR on the tumor side and high LI were associated with higher risk of AKI in PA patients compared to pheochromocytoma patients.
醛固酮诱导的肾小球高滤过可导致原发性醛固酮增多症（PA）患者术前隐匿性肾功能不全。我们评估了PA患者单侧肾上腺切除术后急性肾损伤（AKI）的发生率是否更高。此外，我们还确定了这些患者发生AKI的危险因素。
这项回顾性研究纳入了107例PA患者和186例嗜铬细胞瘤患者作为对照组，所有患者均于2006年1月至2017年11月在延世大学Severance医院接受了肾上腺切除术。主要结局是肾上腺切除术后48小时内发生的AKI。进行单因素和多因素逻辑回归分析以确定肾上腺切除术后AKI的预测因素。
AKI的总体发生率为49/293（16.7%）。在PA患者中，AKI的发生率为29/107（27.1%）。相比之下，嗜铬细胞瘤患者中AKI的发生率为20/186（10.7%）。单因素和多因素逻辑回归分析均显示，与嗜铬细胞瘤患者相比，PA患者术后发生AKI的风险更高。此外，年龄较大、糖尿病、高血压病程较长、术前估计肾小球滤过率较低、醛固酮-皮质醇比值（ACR）较高和侧化指数（LI）较高被确定为PA患者单侧肾上腺切除术后发生术后AKI的独立危险因素。
PA患者手术治疗后术后AKI的发生率和风险显著更高。与嗜铬细胞瘤患者相比，PA患者肿瘤侧的高ACR和高LI与更高的AKI风险相关。
