Skip to main content
SpringerLink
Log in

Evaluation of Intra-Renal Stiffness in Patients with Primary Aldosteronism

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Intorduction

Aldosterone is known to play important role in developing cardiovascular, metabolic, renal damage in hypertensive patients.

Aim

Aim of study was to evaluate parameters obtained by eco-color Doppler study, as non-invasive and easly performed method in asyntomatic patients with Essential Hypertension (EH) and Primary Aldosteronism (PA), without overt organ damage.

Methods

From April 2019 to March 2020 we consecutively enrolled 73 hypertensive subjects (48 males, 25 women), distinguished in two groups: 30 EH patients (mean age 49.5 ± 18.7 years) and 43 PA patients (mean age 53.1 ± 11.6 years)] [23 with aldosterone-secreting adrenal adenoma (APA), 20 with idiopathic aldosteronism (IHA)].

Results

PA group showed higher renal filtration rate and 24-h urinary excretion of albumin respect to EH; moreover, in PA we found higher Pulsatility Index, altered percentage of Renale Resistance Index, Atrophy Index, and reducted parietal thickness than EH. The correlation study showed that plasma aldosterone were positively correlated with pulsatility index in PA group (right r = 0.35; p < 0.05; left r = 0.36; p < 0.05).

Conclusion

parameters obtained through the intra-renal eco-color Doppler examination, easly performed and non-invasive, can be useful in the early-stage identification of subclinical microvascular alterations, especially in PA, condition characterized by increased risk of cardio-vascular remodelling and metabolic alterations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rossi GP, Bisogni V, Bacca AV, Belfiore A, Cesari M, Concistrè A, et al. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens. 2020;15(5): 100029. https://doi.org/10.1016/j.ijchy.2020.100029.

    Article  Google Scholar 

  2. Rossi GP, Bernini G, Caliumi C, Desideri GB, Fabris B, Ferri C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293–300. https://doi.org/10.1016/j.jacc.2006.07.059.

    Article  CAS  PubMed  Google Scholar 

  3. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243–8. https://doi.org/10.1016/j.jacc.2005.01.015.

    Article  CAS  PubMed  Google Scholar 

  4. Petramala L, Concistrè A, Olmati F, Saracino V, Chimenti C, Frustaci A, et al. Cardiomyopathies and adrenal diseases. Int J Mol Sci. 2020;21(14):5047. https://doi.org/10.3390/ijms21145047.

    Article  CAS  PubMed Central  Google Scholar 

  5. Seccia TM, Letizia C, Muiesan ML, Lerco S, Cesari M, Bisogni V, et al. Atrial fibrillation as presenting sign of primary aldosteronism: results of the prospective appraisal on the prevalence of primary aldosteronism in hypertensive (PAPPHY) study. J Hypertens. 2020;38(2):332–9. https://doi.org/10.1097/HJH.0000000000002250.

    Article  CAS  PubMed  Google Scholar 

  6. Iacobellis G, Petramala L, Cotesta D, Pergolini M, Zinnamosca L, Cianci R, et al. Adipokines and cardiometabolic profile in primary hyperaldosteronism. J Clin Endocrinol Metab. 2010;95(5):2391–8. https://doi.org/10.1210/jc.2009-2204.

    Article  CAS  PubMed  Google Scholar 

  7. Petramala L, Pignatelli P, Carnevale R, Zinnamosca L, Marinelli C, Settevendemmie A, et al. Oxidative stress in patients affected by primary aldosteronism. J Hypertens. 2014;32(10):2022–9. https://doi.org/10.1097/HJH.0000000000000284.

    Article  CAS  PubMed  Google Scholar 

  8. Petramala L, Iacobellis G, Carnevale R, Marinelli C, Zinnamosca L, Concistrè A, et al. Enhanced soluble serum CD40L and serum P-selectin levels in primary aldosteronism. Horm Metab Res. 2016;48(7):440–5. https://doi.org/10.1055/s-0042-103588.

    Article  CAS  PubMed  Google Scholar 

  9. Quaia E, Correas JM, Mehta M, Murchison JT, Gennari AG, van Beek EJR. Gray scale ultrasound, color doppler ultrasound, and contrast-enhanced ultrasound in renal parenchymal diseases. Ultrasound Q. 2018;34(4):250–67. https://doi.org/10.1097/RUQ.0000000000000383.

    Article  PubMed  Google Scholar 

  10. Boddi M, Natucci F, Ciani E. The internist and the renal resistive index: truths and doubts. Intern Emerg Med. 2015;10(8):893–905. https://doi.org/10.1007/s11739-015-1289-2.

    Article  PubMed  Google Scholar 

  11. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104. https://doi.org/10.1093/eurheartj/ehy339.

    Article  PubMed  Google Scholar 

  12. Bruni C, Rosato E, Maestripieri V, Gigante A, Tesei G, Bellando-Randone S, et al. The Renal Resistive Index in systemic sclerosis: determinants, prognostic implication and proposal for specific age-adjusted cut-offs. Eur J Intern Med. 2019;70:43–9. https://doi.org/10.1016/j.ejim.2019.09.001.

    Article  PubMed  Google Scholar 

  13. Parolini C, Noce A, Staffolani E, Giarrizzo GF, Costanzi S, Splendiani G. Renal resistive index and long-term outcome in chronic nephropathies. Radiology. 2009;252:888–96. https://doi.org/10.1148/radiol.2523080351.

    Article  PubMed  Google Scholar 

  14. Concistrè A, Petramala L, Bonvicini M, Gigante A, Collalti G, Pellicano C, et al. Comparisons of skin microvascular changes in patients with primary aldosteronism and essential hypertension. Hypertens Res. 2020;43(11):1222–30. https://doi.org/10.1038/s41440-020-0475-4.

    Article  CAS  PubMed  Google Scholar 

  15. Tetsuya A, Michiaki A, Takashi M, Mika M, Yasuharu F, Sadayoshi I, et al. Ratio of diastolic to systolic blood pressure represents renal resistive index. J Hum Hypertens. 2020;34(7):512–9. https://doi.org/10.1038/s41371-019-0264-1.

    Article  CAS  Google Scholar 

  16. Chirinos JA, Townsend RR. Systemic arterial hemodynamics and the ‘“renal resistive index”’: what is in a name? J Clin Hypertens (Greenwich). 2014;16:170–1. https://doi.org/10.1111/jch.12276.

    Article  Google Scholar 

  17. Boddi M. Renal ultrasound (and Doppler sonography) in hypertension: an update. Adv Exp Med Biol Adv Intern Med. 2017;2:191–208. https://doi.org/10.1007/5584_2016_170.

    Article  Google Scholar 

  18. Viazzi F, Leoncini G, Derchi LE, Pontremoli R. Ultrasound Doppler renal resistive index: a useful tool for the management of the hypertensive patient. J Hypertens. 2014;32:149–53. https://doi.org/10.1097/HJH.0b013e328365b29c.

    Article  CAS  PubMed  Google Scholar 

  19. Miyoshi K, Okura T, Tanino A, Kukida M, Nagao T, Higaki J. Usefulness of renal resistive index to predict an increase in urinary albumin excretion in patients with essential hypertension. J Hum Hypertens. 2016. https://doi.org/10.1038/jhh.2016.

    Article  PubMed  Google Scholar 

  20. Geraci G, Mulè G, Paladino G, Zammuto MM, Castiglia A, Scaduto E, et al. Relationship between kidney findings and systemic vascular damage in elderly hypertensive patients without overt cardiovascular disease. J Clin Hypertens (Greenwich). 2017;19(12):1339–47. https://doi.org/10.1111/jch.13127.

    Article  CAS  Google Scholar 

  21. Kaoru K, Noriko Y, Misaki S, Kazuyuki S, Masanori H, Kazuya Y, et al. Associations between increased renal resistive index and cardiovascular events. J Med Ultrason. 2016;43(2):263–70. https://doi.org/10.1007/s10396-015-0680-y.

    Article  Google Scholar 

  22. Mostafa A, Said K, Ammar W, Eltawil AE, Abdelhamid M. New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure. ESC Heart Fail. 2020;7(5):2581–8. https://doi.org/10.1002/ehf2.12835.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nijst P, Martens P, Dupont M, Tang WHW, Mullens W. Intrarenal flow alterations during transition from euvolemia to intravascular volume expansion in heart failure patients. JACC Heart Fail. 2017;5(9):672–81. https://doi.org/10.1016/j.jchf.2017.05.006.

    Article  PubMed  Google Scholar 

  24. Yoshitsugu I, Sadayoshi I, Ryo M, Masataka K, Yoshikiyo O, Masahiro N, et al. Renal resistive index predicts postoperative blood pressure outcome in primary aldosteronism. Hypertension. 2016;67(3):654–60. https://doi.org/10.1161/HYPERTENSIONAHA.115.05924.

    Article  CAS  Google Scholar 

  25. Vin-Cent Wu, Kuo C-C, Wang S-M, Liu K-L, Huang K-H, Lin Y-H, et al. Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment. J Hypertens. 2011;29(9):1778–86. https://doi.org/10.1097/HJH.0b013e3283495cbb.

    Article  CAS  Google Scholar 

  26. Sardo L, Palange P, Di Mario F, Barbano B, Gigante A, Mordenti M, et al. Intrarenal hemodynamic and oxidative stress in patients with obstructive sleep apnea syndrome. Sleep Breath. 2015;19(4):1205–12. https://doi.org/10.1007/s11325-015-1140-z.

    Article  CAS  PubMed  Google Scholar 

  27. Catena C, Colussi GL, Novello M, Fagotto V, Sechi LA. Intrarenal vascular resistance is associated with a prothrombotic state in hypertensive patients. Kidney Blood Press Res. 2016;41(6):929–36. https://doi.org/10.1159/000452594.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Policlinico “Umberto I”, Viale del Policlinico 155, 00185, Rome, Italy

    Luigi Petramala, Antonio Concistrè, Francesco Circosta, Antonietta Gigante, Maurizio Soldini, Rosario Cianci & Claudio Letizia

  2. University Cattolica “Sacro Cuore”, Rome, Italy

    Francesca Sarlo

  3. Department of Clinical, Intenal Medicine, Anesthesiologic and Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy

    Mauro Schina & Gino Iannucci

Authors
  1. Luigi Petramala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Concistrè
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Circosta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonietta Gigante
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesca Sarlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauro Schina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maurizio Soldini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gino Iannucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosario Cianci
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Claudio Letizia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Letizia.

Ethics declarations

Funding

None.

Conflict of interest

The authors declare no competing interests.

Consent to participate

All participants signed informed consent before the study.

Availability of data and material

Available.

Code availability

Not applicable.

Author contributions

Conceptualization: C.L., L.P.; methodology: A.C., F.S., M.S.; software: F.C., M.S., and L.P.; validation: C.L., G.I., and L.P.; formal analysis: A.C., and L.P.; investigation: A.C. and M.S.; resources: C.L., G.I., A.C.; data curation: F.S., M.S.; and A.C.; witing-original draft preparation: L.P., and G.I.; writing-review and editing: C.L. G.I., and L.P.; visualization: L.P.; supervision: C.L., and L.P.; project administration: L.P.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petramala, L., Concistrè, A., Circosta, F. et al. Evaluation of Intra-Renal Stiffness in Patients with Primary Aldosteronism. High Blood Press Cardiovasc Prev 29, 49–56 (2022). https://doi.org/10.1007/s40292-021-00485-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-021-00485-3

Keywords

Search

Navigation