An unmet medical need vs. regulatory recommendations: how should we treat patients with hyperaldosteronism and advanced chronic kidney disease when surgery is not feasible?
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A 40-year-old man presented with resistant arterial hypertension (HTA): his mean blood pressure was 155/91 mm Hg despite treatment with five classes of antihypertensives. He suffered from chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) 24 mL/min due to a long-standing HTA with biopsy-proven nephroangiosclerosis (Online Resource - SM1). His serum aldosterone was 4 times above the upper limit of normal and was not suppressed in the saline infusion test. Multi-slice computed tomography and magnetic resonance imaging indicated normal adrenal glands. Patient did not consider surgery as an option, and it was clear that he would have benefited from aldosterone-antagonizing therapy regarding both hypertension and preservation of the renal function by antagonism of the effects of aldosterone on renal sclerosis .
Two aldosterone antagonists are marketed throughout Europe: spironolactone and eplerenone. Canrenone, a spironolactone metabolite, is marketed as an...
KeywordsHyperaldosteronism Chronic kidney disease Spironolactone Eplerenone
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Conflict of interest
The author declares that she has no conflict of interest.
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