title: Preoperative masked renal damage in Japanese patients with primary aldosteronism: identification of predictors for chronic kidney disease manifested after adrenalectomy.
abstract: OBJECTIVE
  Correct interpretation of renal function in patients with primary aldosteronism is difficult before adrenalectomy, because subtle kidney impairment is often masked by glomerular hyperfiltration peculiar to primary aldosteronism. The aim of this study was to investigate postoperative changes in renal function for patients with primary aldosteronism and to identify clinical predictors of chronic kidney disease manifested postoperatively in the patients without pre-existing chronic kidney disease.
  
  
  METHODS
  Records of 78 Japanese patients who underwent unilateral adrenalectomy for primary aldosteronism were retrospectively surveyed. Patients who had been followed up for <6 months were excluded. Preoperative and postoperative estimated glomerular filtration rate were compared. Furthermore, uni- and multivariate analyses were carried out to identify clinical predictors for chronic kidney disease manifested postoperatively.
  
  
  RESULTS
  Patients with preoperative estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) showed a significant decrease after surgery. Of the 66 patients without pre-existing chronic kidney disease, 24 developed chronic kidney disease postoperatively. Multivariate logistic regression analysis identified a medical history of dyslipidemia as an independent predictor for chronic kidney disease manifested postoperatively. According to univariate analyses, additional factors associated with postoperative manifestation of chronic kidney disease included older age, lower diastolic blood pressure and lower estimated glomerular filtration rate.
  
  
  CONCLUSIONS
  The interpretation of normal or abnormal renal functions by examining estimated glomerular filtration rate heightened by hyperfiltration alone can mislead clinicians before adrenalectomy. Clinicians should pay attention to patients at greater risk of a significant decline in postoperative renal function.
authors.affiliation: Departments of Urology, Chiba University, Chiba, Chiba, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Utsumi
authors.forename: Koji
authors.initials: K
authors.lastname: Kawamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Imamoto
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Nagano
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Naoto
authors.initials: N
authors.lastname: Kamiya
authors.forename: Naoki
authors.initials: N
authors.lastname: Nihei
authors.forename: Yukio
authors.initials: Y
authors.lastname: Naya
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ichikawa
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors