Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China.
Clin Exp Hypertens. 2021 Jan 2;43(1):7-12. doi: 10.1080/10641963.2020.1790586. Epub 2020 Jul 8.
Rare cases of concurrent primary aldosteronism (PA) and renal artery stenosis (RAS) have been reported. In this retrospective case-control study, we selected a cohort of 10 PA with RAS patients and a control group of 20 PA without RAS patients from January 1, 2006, to January 1, 2016. All patients presented with refractory hypertension, and a nonstatistically significant trend toward lower mean serum potassium was seen in the PA with RAS group (p =.07). PA with RAS patients had lower mean orthostatic aldosterone-to-renin ratios (38.4 ± 41.4 ng dL/ng mL h vs. 87.4.4 ± 38.4 ng dL/ng mL h, respectively; p < .01) and a higher false-negative rate (50% vs. 15%, respectively; p < .05) compared with controls. All misdiagnosed patients had the diagnosis of PA confirmed when we revaluated the repeated screening and confirmative tests because of residual hypertension or hypokalemia after successful revascularization of renal artery stenosis. PA is easily missed in patients with RAS because of the high false-negative rate for screening tests. RAS patients with residual hypertension after successful renal angioplasty should be monitored for coexisting PA. Reevaluation of screening and confirmatory tests is helpful in establishing the correct diagnoses.
已报道过并发的原发性醛固酮增多症（PA）和肾动脉狭窄（RAS）的罕见病例。在这项回顾性病例对照研究中，我们从 2006 年 1 月 1 日至 2016 年 1 月 1 日，选择了 10 例伴有 RAS 的 PA 和 20 例不伴有 RAS 的 PA 患者作为队列。所有患者均表现为难治性高血压，伴有 RAS 的 PA 组的平均血清钾水平呈下降趋势，但无统计学意义（p=0.07）。伴有 RAS 的 PA 患者的直立位醛固酮/肾素比值更低（38.4±41.4 ng/dL/ng/mL/h 与 87.4±38.4 ng/dL/ng/mL/h；p<0.01），假阴性率更高（50%与 15%；p<0.05）。与对照组相比，所有误诊患者在重新评估重复筛查和确认试验时，由于肾动脉狭窄成功血运重建后仍存在高血压或低钾血症，均被证实为 PA。由于筛查试验的假阴性率较高，伴有 RAS 的患者容易漏诊 PA。成功血管成形术后仍有高血压的 RAS 患者应监测是否并存 PA。重新评估筛查和确认试验有助于确立正确的诊断。
