title: Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment.
abstract: OBJECTIVE
  To obtain information about the effect of prolonged aldosterone excess on kidney function.
  
  
  METHODS
  We determined kidney function changes defined by cystatin C-based estimations of glomerular filtration rate (CysC-GFR). Pretreatment proteinuria and intrarenal Doppler velocimetric indices in primary aldosteronism were examined and followed after adrenalectomy or spironolactone treatment.
  
  
  RESULTS
  This prospective, multicenter study included 130 primary aldosteronism patients (56 men; age, 49.9 ± 13.4 years: 100 with adenoma and 30 with idiopathic hyperaldosteronism) and 73 essential hypertension patients (36 men; age, 51.4 ± 14.8 years) as controls. Patients with primary aldosteronism had higher CysC-GFR (P < 0.05) and heavier proteinuria (0.042) than those with essential hypertension. With primary aldosteronism, a higher aldosterone-renin ratio (odds ratio, OR = 7.85, P = 0.008) was independently related to pretreatment CysC-GFR. The factors related to pretreatment proteinuria included CysC-GFR (OR, -0.006, P = 0.001), plasma aldosterone concentration (OR, 0.004, P = 0.002), and duration of hypertension (OR, 0.016, P = 0.032). Duration of hypertension was also independently correlated with the pretreatment resistive index among primary aldosteronism patients (OR, 0.004, P = 0.035). CysC-GFR (all, P < 0.05), proteinuria (P < 0.001), and resistive index (P < 0.001) decreased 1 year after adrenalectomy but not with spironolactone treatment.
  
  
  CONCLUSIONS
  Our data suggest that prolonged hyperaldosteronism will cause relative kidney hyperfiltration and reversible intrarenal vascular structural changes, which disguise the consequent renal injury, including declining GFR and proteinuria. Adrenalectomy and spironolactone treatment exert different clinical impacts toward kidney damage even with a similar blood pressure-lowering effect.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei County, Taipei, Taiwan.
authors: Vin-Cent
authors: VC
authors: Wu
authors: Chin-Chi
authors: CC
authors: Kuo
authors: Shuo-Meng
authors: SM
authors: Wang
authors: Kao-Lang
authors: KL
authors: Liu
authors: Kuo-How
authors: KH
authors: Huang
authors: Yen-Hung
authors: YH
authors: Lin
authors: Tzong-Shinn
authors: TS
authors: Chu
authors: Hung-Wei
authors: HW
authors: Chang
authors: Chien-Yu
authors: CY
authors: Lin
authors: Chia-Ti
authors: CT
authors: Tsai
authors: Lian-Yu
authors: LY
authors: Lin
authors: Shih-Chieh
authors: SC
authors: Chueh
authors: Tze-Wah
authors: TW
authors: Kao
authors: Yung-Ming
authors: YM
authors: Chen
authors: Wen-Chih
authors: WC
authors: Chiang
authors: Tun-Jun
authors: TJ
authors: Tsai
authors: Yi-Luwn
authors: YL
authors: Ho
authors: Shuei-Liong
authors: SL
authors: Lin
authors: Wei-Jei
authors: WJ
authors: Wang
authors: Kwan-Dun
authors: KD
authors: Wu
mesh_terms: D000328:Adult; D055316:Cystatin C / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000503:physiopathology* / Q000628:therapy*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000503:physiopathology*
chemical_list: D055316:Cystatin C