Stanford Hypertension Center and Division of Nephrology, Department of Medicine, School of Medicine, Stanford University, Stanford, California.
Stanford Hypertension Center and Division of Nephrology, Department of Medicine, School of Medicine, Stanford University, Stanford, California.
Am J Kidney Dis. 2023 Sep;82(3):333-346. doi: 10.1053/j.ajkd.2023.01.447. Epub 2023 Mar 23.
A clinical condition may be missed due to its higher-than-recognized prevalence or inadequate diagnostic screening. Both factors apply to primary aldosteronism, which is woefully underdiagnosed as a cause of hypertension and end-organ damage. Screening tests should be strongly considered for diseases that pose significant morbidity or mortality if left untreated, that have a high prevalence, and that have treatments that lead to improvement or cure. In this review we present the evidence for each of these points. We outline studies that estimate the prevalence of primary aldosteronism in different at-risk populations and how its recognition has changed over time. We also evaluate myriad studies of screening rates for primary aldosteronism and what factors do and do not influence current screening practices. We discuss the ideal conditions for screening, measuring the aldosterone to renin ratio in different populations that use plasma renin activity or direct renin concentration, and the steps for diagnostic workup of primary aldosteronism. Finally, we conclude with potential strategies to implement higher rates of screening and diagnosis of this common, consequential, and treatable disease.
一种临床病症可能会被漏诊，原因是其发病率高于已知水平，或是诊断筛查不充分。醛固酮增多症就是这种情况，它作为高血压和靶器官损害的病因，未被充分诊断，令人遗憾。如果不治疗，疾病会造成严重的发病率和死亡率，具有较高的发病率，且治疗方法可改善或治愈疾病，那么就应该强烈考虑对这些疾病进行筛查。在这篇综述中，我们将提出每一点的证据。我们概述了估计不同高危人群中醛固酮增多症发病率的研究，以及随着时间的推移，其认知度是如何变化的。我们还评估了大量关于醛固酮增多症筛查率的研究，以及哪些因素会和不会影响当前的筛查实践。我们讨论了在不同人群中筛查的理想条件，即使用血浆肾素活性或直接肾素浓度测量醛固酮与肾素的比值，以及醛固酮增多症诊断性检查的步骤。最后，我们得出结论，提出了实施这种常见、严重和可治疗疾病更高筛查和诊断率的潜在策略。
