Division of Urology, Department of Surgery, Chu Shang Show Chwan Hospital, Nantou, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
BMC Nephrol. 2024 Oct 13;25(1):347. doi: 10.1186/s12882-024-03750-4.
Primary aldosteronism (PA), which is present in 5-18% of hypertensive patients, is a leading cause of secondary hypertension. Adrenalectomy is often recommended for patients with unilateral primary aldosteronism (uPA), yielding good long-term outcomes. PA patients without hyperuricemia and chronic renal failure before adrenalectomy were enrolled in this cohort study. Serum uric acid (SUA) and renal filtration were measured one year post-adrenalectomy. Their relationships with pathologic features, histopathological subtype (classical or nonclassical (HISTALDO consensus)), and vessel stiffness were explored. The aim of this cohort study is to evaluate the correlation between post-adrenalectomy serum uric acid (SUA) levels and estimated glomerular filtration rate (eGFR) with the pathologic features delineated by the HISTALDO consensus. Additionally, the study seeks to assess the impact of these biochemical markers on peripheral vessel stiffness and brachial-ankle pulse wave velocity (baPWV) at a one-year follow-up visit.
This prospective cohort study included patients (N = 100) diagnosed with uPA who underwent adrenalectomy from Jan 1, 2007 to Dec 31, 2022.
At follow-up, elevated SUA, hyperuricemia, and a > 25% eGFR decrease were significantly more common in the classical than the nonclassical group. The incidence of postoperative hyperuricemia, herein referred to as post-adrenalectomy hyperuricemia (PAHU), was 29% (29/100) overall, 34.8% (23/66) in the classical group and 17.6% (6/34) in the nonclassical group. The incidence of eGFR reduction > 25% was 33% (33/100), 43.9% (29/66), and 11.8% (4/34), respectively. baPWV decreased more in the classical group than the nonclassical group.
For PA patients with PAHU and/or renal impairment, we suggest monitoring SUA, pH, urine uric acid, and urine crystals and performing a KUB study and peripheral vascular and renal sonography (on which pure uric acid stones in the KUB are radiolucent) to determine whether drug intervention is required for cases of asymptomatic PAHU, especially patients in male gender, classical histopathology, or renal impairment.
原发性醛固酮增多症（PA）在高血压患者中的占比为 5-18%，是继发性高血压的主要病因。对于单侧原发性醛固酮增多症（uPA）患者，通常建议进行肾上腺切除术，这种手术能带来良好的长期效果。本队列研究纳入了术前无高尿酸血症和慢性肾衰竭的 PA 患者。术后一年，测量患者的血清尿酸（SUA）和肾小球滤过率。分析 SUA 与术后病理特征、组织病理学亚型（经典或非经典（HISTALDO 共识））和血管僵硬之间的关系。本队列研究旨在评估术后 SUA 水平与 HISTALDO 共识定义的病理特征之间的相关性，同时评估这些生化标志物对术后 1 年时外周血管僵硬和肱踝脉搏波速度（baPWV）的影响。
本前瞻性队列研究纳入了 2007 年 1 月 1 日至 2022 年 12 月 31 日期间接受肾上腺切除术的 uPA 患者（N=100）。
随访时，经典组中更常见的是 SUA 升高、高尿酸血症和 eGFR 降低超过 25%。术后高尿酸血症（post-adrenalectomy hyperuricemia，PAHU）的总发生率为 29%（29/100），经典组为 34.8%（23/66），非经典组为 17.6%（6/34）。eGFR 降低超过 25%的发生率分别为 33%（33/100）、43.9%（29/66）和 11.8%（4/34）。经典组的 baPWV 下降更为明显。
对于患有 PAHU 和/或肾功能损害的 PA 患者，我们建议监测 SUA、pH 值、尿尿酸和尿晶体，并进行 KUB 研究和外周血管及肾脏超声检查（KUB 上纯尿酸结石为不透射线），以确定是否需要对无症状 PAHU 进行药物干预，尤其是男性、经典组织病理学或肾功能损害患者。
