Aldosterone and the Kidney

Abstract

The mineralocorticoid aldosterone is a key regulator of blood pressure, fluid and electrolyte homeostasis, and acts via the mineralocorticoid receptor (MR). In recent years, an increasing number of studies revealed deleterious effects of aldosterone via its receptor. Especially in patients with primary hyperaldosteronism (PHA) a significant higher risk of developing cardiovascular comorbidities and comortalities was reported. Also renal insufficiency is clearly increased in patients with PHA indicating a role of aldosterone and the MR in the pathogenesis of renal injury. It has been shown that aldosterone in combination with an elevated salt intake, leads to renal inflammation, fibrosis, podocyte injury, and mesangial cell proliferation. This review focuses on the current knowledge of aldosterone effects in the kidney and highlights this topic from 2 perspectives: from clinical medicine and from experimental studies.

Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism

“…In addition, the correction rates for glomerular hyperfiltration and microalbuminuria were similar among patients with PA who received MRAs or underwent adrenalectomy [4,7]. However, we experienced complications that were related to hypoaldosteronism, which can contribute to glomerular hyperfiltration and volume retention, and subsequently lead to incorrectly low serum creatinine levels and overestimated eGFR values [22,23]. Nevertheless, hypoaldosteronism treatment increases serum creatinine levels and reduces the GFR, which is associated with posttreatment hyperkalemia [20].…”

Clinical risk factors of postoperative hyperkalemia after adrenalectomy in patients with aldosterone-producing adenoma

“…Accordingly, the overproduction of aldosterone alters renal sodium and potassium handling and induces inflammation, fibrosis, mesangial cell proliferation, and podocyte injury in the kidney (18). Aldosterone excess leads to vasodilation in afferent and efferent arterioles, contributing to glomerular hyperfiltration in untreated patients (19,20). Hence, hypoaldosteronism after adrenalectomy increases serum creatinine and reduces GFR, which may lead to marked decreases in salt and water delivery, as well as reduced potassium secretion in the distal region (21).…”

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

“…Although aldosterone excess as in PA is known to cause additional deleterious effects on the kidney (34), there are only a few studies investigating effectiveness of PA therapy on renal function. Ribstein et al (11) reported a decrease in urinary albumin excretion after ADX in 25 PA patients who were followed up for 6 months.…”