An unmet medical need vs. regulatory recommendations: how should we treat patients with hyperaldosteronism and advanced chronic kidney disease when surgery is not feasible?

  • Ivana MikačićEmail author
Letter to the Editor

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 [1].

Two aldosterone antagonists are marketed throughout Europe: spironolactone and eplerenone. Canrenone, a spironolactone metabolite, is marketed as an...


Hyperaldosteronism Chronic kidney disease Spironolactone Eplerenone 


Compliance with ethical standards

Conflict of interest

The author declares that she has no conflict of interest.

Supplementary material

228_2019_2774_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19.3 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Unit for Clinical PharmacologyUniversity Hospital “Sveti Duh”ZagrebCroatia
  2. 2.Department of Internal Medicine, School of MedicineUniversity of ZagrebZagrebCroatia

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