Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Abstract

Background: The renal damage that is present in primary aldosteronism might reflect functional and potentially reversible abnormalities that are initiated by glomerular hyperfiltration. The aim of this study was to investigate the relationships of plasma renin and aldosterone concentrations with renal outcomes after treatment of primary aldosteronism.Design, setting, participants, and measurements: Fifty-six consecutive patients who had primary aldosteronism and were recruited in a university center were studied. Patients were prospectively followed after either surgical or medical treatment for a mean of 6.2 yr, during which they received antihypertensive drugs to reach a target BP of <140/90 mmHg.Results: At baseline, patients with primary aldosteronism had higher creatinine clearance and albuminuria than 323 patients with essential hypertension and 113 normotensive individuals. In patients with primary aldosteronism, plasma active renin levels that were higher than the lower limit of detection (2.5 pg/ml) were associated with higher BP, plasma potassium, and albuminuria and lower creatinine clearance. Plasma aldosterone concentrations that were higher than the median value (225 pg/ml) were associated with lower plasma potassium and higher creatinine clearance. Creatinine clearance was correlated directly with plasma aldosterone and inversely with renin. During follow-up, patients with higher baseline plasma renin required use of more antihypertensive drugs to obtain BP control and had a smaller early decline in albuminuria than did patients with suppressed renin.Conclusions: Escape of renin from suppression by excess aldosterone is associated with evidence of more severe renal damage in patients with primary aldosteronism and predicts less favorable outcomes after treatment.

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

“…50 Five other studies, with spironolactone uptitrated as needed and tolerated, revealed effects no different from those of surgery. [44][45][46]48,53,55 PA patients treated with spironolactone or amiloride experience an improvement in wellbeing similar to that observed after adrenalectomy, although these effects appear to be established more slowly. 86 …”

“…40 They are most marked in patients with unilateral PA 41,42 and are reversed within one month of adrenalectomy (Figure 1). 40,[43][44][45][46][47][48][49][50][51][52][53][54][55] Hemodynamic stress and hyperaldosteronism per se lead to chronic structural damage in the long run. 45,56 PA patients have been reported to display a certain level of insulin resistance, which may improve after adrenalectomy.…”

“…40,[43][44][45][46][47][48][49][50][51][52][53][54][55] Hemodynamic stress and hyperaldosteronism per se lead to chronic structural damage in the long run. 45,56 PA patients have been reported to display a certain level of insulin resistance, which may improve after adrenalectomy. 57,58 However, PA patients have the same likelihood of clinically defined glucose and lipid metabolism disorders at diagnosis as similar patients with essential hypertension, and adrenalectomy does not improve their clinical metabolic profile.…”

“…36,37 The relative glomerular hyperfiltration and microalbuminuria of PA patients are corrected on specific drugs (Figure 1). 40,[44][45][46]50,51,[53][54][55] Spironolactone was found to be less effective than surgery for achieving this end in one study using a fixed low dose (50 mg/day). 50 Five other studies, with spironolactone uptitrated as needed and tolerated, revealed effects no different from those of surgery.…”

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

“…The incidence of a composite endpoint (myocardial infarction, coronary revascularization, stroke, and sustained arrhythmia) did not differ between PA patients treated with spironolactone and those treated by surgery, or between patients with PA and patients with essential hypertension (22). The rate of correction of glomerular hyperfiltration and microalbuminuria has been found to be similar in patients with PA given MRAs and those undergoing adrenalectomy (31,33). Another study reported that the quality of life is lower in patients with unilateral PA than in the general population, and that administration of spironolactone or amiloride improves the quality-of-life scores after 6 months; however, the improvement was slower and smaller on medication than following surgery (34).…”