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International Urology and Nephrology

, Volume 50, Issue 10, pp 1887–1895 | Cite as

Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function

  • Il Young Kim
  • In Seong Park
  • Min Jeong Kim
  • Miyeun Han
  • Harin Rhee
  • Eun Young Seong
  • Dong Won Lee
  • Soo Bong Lee
  • Ihm Soo Kwak
  • Sang Heon SongEmail author
  • Hyun Chul ChungEmail author
Nephrology - Original Paper

Abstract

Purpose

Glomerular filtration rate (GFR) has been reported to decrease after unilateral adrenalectomy in patients with primary aldosteronism (PA). The aim of this study was to identify clinical predictors for decreased GFR after adrenalectomy in patients with PA.

Methods

The records of 187 patients (98 patients with PA and 89 with non-PA adrenal disease) who were followed up for at least 6 months after unilateral adrenalectomy were retrospectively analyzed. Estimated GFR (eGFR) was investigated at 1, 3, and 6 months postoperatively. Preoperative risk factors for eGFR% decline at 1 month ([preoperative eGFR−eGFR at 1 month]/preoperative eGFR × 100) and postoperative CKD development were investigated.

Results

The eGFR decreased significantly at 1 month and remained stable in the PA group. However, there were no significant changes in eGFR in the non-PA group over the 6-month period. In the PA group, a high preoperative eGFR and high aldosterone to renin ratio (ARR) were independently associated with eGFR% decline at 1 month. In patients with PA but without preoperative CKD (n = 68), a low preoperative eGFR and high ARR were independent risk factors for developing postoperative CKD. The best preoperative cut-off values of eGFR and ARR for predicting the development of postoperative CKD were ≤ 102 ml/min/1.73 m2 and ≥ 448 ng/dl:ng/ml/h, respectively.

Conclusions

Renal function deteriorated significantly after unilateral adrenalectomy in patients with PA. Clinicians must pay attention to postoperative renal function in PA patients at elevated risk of developing decreased kidney function.

Keywords

Adrenalectomy Chronic kidney disease Glomerular filtration rate Primary aldosteronism 

Notes

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For the retrospective type of this study formal consent is not required.

References

  1. 1.
    Jin DC, Yun SR, Lee SW, Han SW, Kim W, Park J (2016) Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients. Kidney Res Clin Pract 35:204–211.  https://doi.org/10.1016/j.krcp.2016.09.006 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F, Investigators PS (2006) A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 48:2293–2300.  https://doi.org/10.1016/j.jacc.2006.07.059 CrossRefPubMedGoogle Scholar
  3. 3.
    Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, Papadopoulos N, Vogiatzis K, Zamboulis C (2008) Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 371:1921–1926.  https://doi.org/10.1016/S0140-6736(08)60834-X CrossRefPubMedGoogle Scholar
  4. 4.
    Fogari R, Preti P, Zoppi A, Rinaldi A, Fogari E, Mugellini A (2007) Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. Hypertens Res 30:111–117.  https://doi.org/10.1291/hypres.30.111 CrossRefPubMedGoogle Scholar
  5. 5.
    Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ (2005) Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 45:1243–1248.  https://doi.org/10.1016/j.jacc.2005.01.015 CrossRefPubMedGoogle Scholar
  6. 6.
    Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F, Participants PS (2006) Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 48:232–238.  https://doi.org/10.1161/01.HYP.0000230444.01215.6a CrossRefPubMedGoogle Scholar
  7. 7.
    Ribstein J, Du Cailar G, Fesler P, Mimran A (2005) Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 16:1320–1325.  https://doi.org/10.1681/ASN.2004100878 CrossRefPubMedGoogle Scholar
  8. 8.
    Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C (2006) Long-term renal outcomes in patients with primary aldosteronism. JAMA 295:2638–2645.  https://doi.org/10.1001/jama.295.22.2638 CrossRefPubMedGoogle Scholar
  9. 9.
    Utsumi T, Kawamura K, Imamoto T, Nagano H, Tanaka T, Kamiya N, Nihei N, Naya Y, Suzuki H, Ichikawa T (2013) Preoperative masked renal damage in Japanese patients with primary aldosteronism: identification of predictors for chronic kidney disease manifested after adrenalectomy. Int J Urol 20:685–691.  https://doi.org/10.1111/iju.12029 CrossRefPubMedGoogle Scholar
  10. 10.
    Park SM, Jung WJ, Park JM, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Shin N, Song SH (2016) Unmasked chronic renal function deterioration after unilateral adrenalectomy in patients with primary aldosteronism. Kidney Res Clin Pract 35:255–258.  https://doi.org/10.1016/j.krcp.2016.05.002 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wu VC, Yang SY, Lin JW, Cheng BW, Kuo CC, Tsai CT, Chu TS, Huang KH, Wang SM, Lin YH, Chiang CK, Chang HW, Lin CY, Lin LY, Chiu JS, Hu FC, Chueh SC, Ho YL, Liu KL, Lin SL, Yen RF, Wu KD, Group TS (2011) Kidney impairment in primary aldosteronism. Clin Chim Acta 412:1319–1325.  https://doi.org/10.1016/j.cca.2011.02.018 CrossRefPubMedGoogle Scholar
  12. 12.
    Iwakura Y, Morimoto R, Kudo M, Ono Y, Takase K, Seiji K, Arai Y, Nakamura Y, Sasano H, Ito S, Satoh F (2014) Predictors of decreasing glomerular filtration rate and prevalence of chronic kidney disease after treatment of primary aldosteronism: renal outcome of 213 cases. J Clin Endocrinol Metab 99:1593–1598.  https://doi.org/10.1210/jc.2013-2180 CrossRefPubMedGoogle Scholar
  13. 13.
    Tanase-Nakao K, Naruse M, Nanba K, Tsuiki M, Tagami T, Usui T, Okuno H, Shimatsu A, Hashimoto S, Katabami T, Ogo A, Okumura A, Umakoshi H, Suzuki T (2014) Chronic kidney disease score for predicting postoperative masked renal insufficiency in patients with primary aldosteronism. Clin Endocrinol 81:665–670.  https://doi.org/10.1111/cen.12497 CrossRefGoogle Scholar
  14. 14.
    Kim do H, Kwon HJ, Ji SA, Jang HR, Jung SH, Kim JH, Kim JH, Lee JE, Huh W, Kim YG, Kim DJ, Oh HY (2016) Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism. Medicine 95:e3930.  https://doi.org/10.1097/MD.0000000000003930 CrossRefPubMedGoogle Scholar
  15. 15.
    Ferrari P, Shaw SG, Nicod J, Saner E, Nussberger J (2004) Active renin versus plasma renin activity to define aldosterone-to-renin ratio for primary aldosteronism. J Hypertens 22:377–381CrossRefPubMedGoogle Scholar
  16. 16.
    Kem DC, Weinberger MH, Mayes DM, Nugent CA (1971) Saline suppression of plasma aldosterone in hypertension. Arch Intern Med 128:380–386CrossRefPubMedGoogle Scholar
  17. 17.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C (2009) Intrarenal hemodynamics in primary aldosteronism before and after treatment. J Clin Endocrinol Metab 94:1191–1197.  https://doi.org/10.1210/jc.2008-2245 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kuo CC, Wu VC, Tsai CW, Wu KD, Taiwan Primary Aldosteronism Investigation Study G (2011) Relative kidney hyperfiltration in primary aldosteronism: a meta-analysis. J Renin Angiotensin Aldosterone Syst 12:113–122.  https://doi.org/10.1177/1470320310391331 CrossRefPubMedGoogle Scholar
  20. 20.
    Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA (2007) Relationships of plasma renin levels with renal function in patients with primary aldosteronism. Clin J Am Soc Nephrol 2:722–731.  https://doi.org/10.2215/CJN.00050107 CrossRefPubMedGoogle Scholar
  21. 21.
    Hollenberg NK (2004) Aldosterone in the development and progression of renal injury. Kidney Int 66:1–9.  https://doi.org/10.1111/j.1523-1755.2004.00701.x CrossRefPubMedGoogle Scholar
  22. 22.
    Danforth DN Jr, Orlando MM, Bartter FC, Javadpour N (1977) Renal changes in primary aldosteronism. J Urol 117:140–144CrossRefPubMedGoogle Scholar
  23. 23.
    Catena C, Colussi GL, Marzano L, Sechi LA (2012) Predictive factors of left ventricular mass changes after treatment of primary aldosteronism. Horm Metab Res 44:188–193.  https://doi.org/10.1055/s-0032-1301902 CrossRefPubMedGoogle Scholar
  24. 24.
    Favia G, Lumachi F, Scarpa V, D’Amico DF (1992) Adrenalectomy in primary aldosteronism: a long-term follow-up study in 52 patients. World J Surg 16:680–683. (discussion 683–684)CrossRefPubMedGoogle Scholar
  25. 25.
    Catena C, Colussi G, Sechi LA (2015) Treatment of primary aldosteronism and organ protection. Int J Endocrinol 2015:597247.  https://doi.org/10.1155/2015/597247 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicinePusan National University School of MedicineYangsanRepublic of Korea
  2. 2.Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanRepublic of Korea
  3. 3.Biomedical Research InstitutePusan National University HospitalBusanRepublic of Korea
  4. 4.Department of Internal MedicinePusan National University HospitalBusanRepublic of Korea
  5. 5.Department of Internal MedicineUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea

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