Early Renin Recovery After Adrenalectomy in Aldosterone-Producing
                    Adenomas: A Prospective Study

Mermejo, Lívia Mara; Elias, Paula Condé Lamparelli; Molina, Carlos A.; Tucci, Sílvio; Muglia, Valdair Francisco; Elías, Jorge; Antonini, Sonir R; Castro, Margaret de; Moreira, Ayrton Custódio

doi:10.1055/a-1778-4002

Cited by 4 publications

(3 citation statements)

References 37 publications

(93 reference statements)

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“…Recently, Mermejo et al [32] showed that postoperative suppressed renin levels became detectable between fifteen and thirty days after unilateral adrenalectomy in 13 patients with unilateral PA. Evaluating a large cohort of 94 PA patients, we demonstrated that renin levels increased during the first month of adrenalectomy, but renin concentrations became higher when compared to immediate postoperative levels only after 3 months of adrenalectomy.…”

Section: First Week After Surgery 1 Month After Surgery 3 Months Afte...mentioning

confidence: 99%

Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism

Queiroz,

Stumpf,

Souza

et al. 2023

Horm Metab Res

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Few studies demonstrated a percentage decrease in the estimated glomerular filtration rate (eGFR) at a single time and the rate of hypoaldosteronism after adrenalectomy for primary aldosteronism (PA). To investigate the evolution of renal function and the hypoaldosteronism risk after adrenalectomy for PA. Aldosterone, renin, eGFR, and electrolyte levels were determined before and at 1 week, 1, 3 and 6 months after unilateral adrenalectomy in 94 PA patients (40 men and 54 women). The main outcome was the postoperative eGFR decline using analysis of covariance with the preoperative eGFR as a covariate. eGFR decreased during first postoperative week compared to 3 months before surgery. During the first 6 months, eGFR remained stable at similar levels to the first week after surgery. Age (p=0.001), aldosterone levels (p=0.021) and eGFR 3 months before surgery (p<0.0001) had a significant correlation with eGFR during first postoperative week. High aldosterone levels at diagnosis were correlated with decline in renal function in the univariate model (p=0.033). In the multivariate analysis, aldosterone levels at diagnosis had a tendency to be an independent predictor of renal function after surgery (p=0.059). Postoperative biochemical hypoaldosteronism was diagnosed in 48% of the cases after adrenalectomy, but prolonged hyperkalemia occurred in only 4 cases (4.5%). Our findings showed a decrease of eGFR after unilateral adrenalectomy for PA. Additionally, aldosterone levels at diagnosis correlated with postoperative renal function. Postoperative biochemical hypoaldosteronism occurred in almost half of the patients, but prolonged hyperkalemia with fludrocortisone replacement was less frequent.

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Section: First Week After Surgery 1 Month After Surgery 3 Months Afte...mentioning

confidence: 99%

Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism

Queiroz,

Stumpf,

Souza

et al. 2023

Horm Metab Res

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“…Hypoaldosteronism is defined by aldosterone deficiency or resistance and is often referred to as "type 4 RTA." Aldosterone deficiency may be the result of hyporeninism-hypoaldosteronism in patients with diabetes or kidney function impairment; angiotensin inhibitor use, such as angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs); primary adrenal insufficiency; anticoagulation by heparin [10]; hereditary enzymatic deficiencies such as aldosterone synthase deficiency [11,12] or Gordon's syndrome [13]; a severe illness condition due to adrenocorticotropic hormone (ACTH) hypersecretion, which diverts the substrate to cortisol synthesis [14]; or a transient hypoaldosteronism following surgical treatment of hyperaldosteronism [15]. Aldosterone resistance is usually iatrogenic due to the administration of potassium-sparing diuretics [16] or antibiotics such as trimethoprim [5,6] or pentamidine [17].…”

Section: Introductionmentioning

confidence: 99%

Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients

Mohib,

Vanderhulst,

Catalano

et al. 2024

Cureus

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Introduction: The occurrence of hyperkalemic renal tubular acidosis (RTA) in the post-transplantation period is likely underestimated, and its identification remains important to offer adequate medical management. Transplant recipients frequently present with clinical and biological characteristics that may be associated with the occurrence of this complication.Methods: This was a single-center retrospective study that compared transplanted patients with hyperkalemic RTA and a control group to identify variables associated with the occurrence of this complication. Fisher's exact test and the Mann-Whitney test, followed by multivariate logistic regression, were applied to test whether there was a significant association between hyperkalemic RTA and different variables.Results: Kidney and heart transplant recipients were at greater risk of developing RTA than lung transplant recipients (p = 0.016). There was also a significant association between the development of RTA and kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01). The significant impact of these last three variables was confirmed by the results of the multivariate logistic regression. Residual serum tacrolimus levels (p = 0.13) and creatinine levels (p = 0.17) of renal transplant patients were not significantly associated with hyperkalemic RTA. Conclusion:The type of transplanted organ, kalemia, chloremia, and bicarbonatemia were significantly associated with the occurrence of hyperkalemic RTA. This study calls into question certain approaches to managing this complication proposed in a number of case reports, such as reducing the target serum residual of tacrolimus or discontinuing trimethoprim-sulfamethoxazole (TMP-SMX) in favor of another antibiotic prophylactic agent, potentially exposing patients to graft rejection and opportunistic infections.

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“…Hypoaldosteronism is de ned by aldosterone de ciency or resistance and is often referred to as "type 4 RTA." Aldosterone de ciency may be the result of hyporeninism-hypoaldosteronism in patients with diabetes or kidney function impairment; angiotensin inhibitor use such as ACEi or ARB; primary adrenal insu ciency; anticoagulation by heparin [12]; hereditary enzymatic de ciencies such as aldosterone synthase de ciency [13,14] or Gordon's syndrome [15]; severe illness condition due to adrenocorticotropic hormone (ACTH) hypersecretion, which diverts the substrate to cortisol synthesis [16]; or a transient hypoaldosteronism following a surgical treatment of hyperaldosteronism [17].…”

mentioning

confidence: 99%

Clinical and biological factors predisposing to hyperkalemic renal tubular acidosis in solid organ transplant recipients : a retrospective monocentric study

Mohib

Vanderhulst

Catalano

et al. 2023

Preprint

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Background The occurrence of hyperkalemic renal tubular acidosis in the post-transplantation period is likely underestimate, and its identification remains important to offer adequate medical management. Transplanted recipients frequently present clinical and biological characteristics which are associated in the literature with the occurrence of this complication. Post-transplant exposure to drugs that cause hyperkalemic renal tubular acidosis may therefore appear risky. We conducted a single-center retrospective comparative study in which we compared patients with hyperkalemic renal tubular acidosis and a control group to identify clinical and biological factors significantly associated with this complication.Methods The Fisher’s exact test was applied to test whether there is a significant association between hyperkalemic renal tubular acidosis and qualitative variable. The Mann-Whitney test was applied for the quantitative variables. We performed a multivariate logistic regression excluding some variables and then selected the variables using a stepwise procedure. The best logistic model according to the Akaike Information Criterion was the final model.Results Kidney and heart transplant recipients appear to be at greater risk of developing this complication than lung transplant recipients (p = 0.016). No other qualitative variable showed a significant association with the occurrence of hyperkalemic RTA. We also found a significant difference in kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01).Neither the residual serum tacrolimus level (p = 0.19) nor the creatinine level of renal transplant patients (p = 0.17) was significantly associated with hyperkalemic renal tubular acidosis. In multivariate logistic regression, the analysis of the final model confirms the significant impact of kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p = 0.013) in the occurrence of this complication.Conclusion In our study, the type of transplanted organ, kalemia, chloremia, and bicarbonatemia seem to be significantly associated with the occurrence of hyperkalemic renal tubular acidosis. It is essential to identify this complication and to treat hyperkalemia first before proposing additional treatments. Larger studies are needed to more accurately define transplanted patients at risk for hyperkalemic renal tubular acidosis.

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Early Renin Recovery After Adrenalectomy in Aldosterone-Producing Adenomas: A Prospective Study

Cited by 4 publications

References 37 publications

Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism

Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism

Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients

Clinical and biological factors predisposing to hyperkalemic renal tubular acidosis in solid organ transplant recipients : a retrospective monocentric study

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