Fahmy H I, Melby J C, Mesler D E, Beazley R M, Cho S I, Idelson B A
Department of Medicine, Boston Medical Center, MA, USA.
Am J Kidney Dis. 1998 May;31(5):853-5. doi: 10.1016/s0272-6386(98)70056-3.
A 58 year-old man with end-stage renal disease who had received a cadaveric renal transplant presented with persistent hypertension and hypokalemia. Allograft renal artery stenosis, rejection, and cyclosporine effects were excluded. Hypokalemia persisted despite potassium supplementation and antihypertensive medications with hyperkalemic effects. The biochemical findings of primary hyperaldosteronism with a normal adrenal anatomy imaged by magnetic resonance imaging (MRI) necessitated adrenal vein sampling to lateralize a left adrenal adenoma. His hypokalemia was cured by the removal of the adenoma, and his blood pressure (BP) control was easily achieved with a less complex regimen of antihypertensives. We suggest that the concomitant existence of resistant hypokalemia and posttransplantation hypertension, especially in the cyclosporine era, should stimulate a search for hyperaldosteronism; once transplant renal artery stenosis has been excluded, the patient should be investigated for primary hyperaldosteronism. When imaging studies fail to show adrenal pathology, adrenal vein sampling will likely do so.
一名58岁的终末期肾病男性患者，接受了尸体肾移植，出现持续性高血压和低钾血症。排除了移植肾动脉狭窄、排斥反应和环孢素的影响。尽管补充了钾并使用了具有升高血钾作用的抗高血压药物，但低钾血症仍持续存在。磁共振成像（MRI）显示肾上腺解剖结构正常的原发性醛固酮增多症的生化检查结果，需要进行肾上腺静脉采血以确定左侧肾上腺腺瘤的位置。切除腺瘤后治愈了他的低钾血症，并且通过使用不太复杂的抗高血压药物方案轻松实现了血压控制。我们建议，尤其是在环孢素时代，耐药性低钾血症和移植后高血压同时存在时，应促使寻找醛固酮增多症；一旦排除了移植肾动脉狭窄，就应对患者进行原发性醛固酮增多症的检查。当成像研究未显示肾上腺病变时，肾上腺静脉采血可能会显示。
