Nakada T, Koike H, Katayama T
Department of Urology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan.
Urol Int. 1987;42(4):295-301. doi: 10.1159/000281962.
Of 15 patients with primary aldosteronism, 7 had idiopathic adrenal hyperplasia (IHA) and 8 had aldosterone-producing adenoma (APA). In order to determine any renal problems involved in the treatment, the renal clearance of these patients was analyzed and the results compared with those obtained from 12 patients with essential hypertension. With water diuresis or under antidiuresis status, levels of urine volume, Cosm and CH2O in patients with APA were greater (p less than 0.05-p less than 0.001) than those of patients with essential hypertension, while the fractional tubular sodium delivery of the former patients was lower than that of the latter patients (p less than 0.001 or less than 0.05). A similar tendency was observed in clearance studies in patients with IHA, although to a lesser extent. Adrenal surgery for patients with APA normalized these values, but administration of trilostane (3 beta-hydrosteroid dehydrogenase inhibitor) to patients with IHA failed to improve these values. These results indicate that impaired urinary concentrating ability as well as reduced urinary diluting capability is a common feature of primary aldosteronism. Such impaired renal function was improved only in patients with APA after adrenal surgery.
在15例原发性醛固酮增多症患者中，7例患有特发性肾上腺增生（IHA），8例患有醛固酮瘤（APA）。为了确定治疗中涉及的任何肾脏问题，对这些患者的肾脏清除率进行了分析，并将结果与12例原发性高血压患者的结果进行了比较。在水利尿或抗利尿状态下，APA患者的尿量、菊粉清除率（Cosm）和自由水清除率（CH2O）水平高于原发性高血压患者（p<0.05 - p<0.001），而前者患者的肾小管钠排泄分数低于后者患者（p<0.001或<0.05）。IHA患者的清除率研究中也观察到类似趋势，尽管程度较轻。对APA患者进行肾上腺手术可使这些值恢复正常，但对IHA患者给予曲洛司坦（3β - 羟类固醇脱氢酶抑制剂）未能改善这些值。这些结果表明，尿浓缩能力受损以及尿稀释能力降低是原发性醛固酮增多症的共同特征。只有APA患者在肾上腺手术后肾功能受损得到改善。
