This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (29)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Renal Diseases  • Renal Diseases, Other  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Leonardo A. Sechi, MD; Marileda Novello, MD; Roberta Lapenna, MD; Sara Baroselli, MD; Elisa Nadalini, MD; Gian Luca Colussi, MD; Cristiana Catena, MD, PhD

JAMA. 2006;295:2638-2645.

Context  Experimental animal studies indicate that exposure to increased aldosterone levels might result in renal damage, but the clinical evidence supporting this role of aldosterone is preliminary.

Objective  To determine the long-term outcome of renal function in patients with primary aldosteronism after surgical or medical treatment.

Design, Setting, and Participants  Prospective study conducted at an Italian university medical center among a consecutive sample of 50 patients who were diagnosed as having primary aldosteronism between January 1994 and December 2001 and who were followed up for a mean of 6.4 years after treatment with adrenalectomy or spironolactone. Patients with primary aldosteronism were compared with 100 patients with essential hypertension, matched for severity and duration of hypertension. All patients were treated with antihypertensive drugs to reach a target blood pressure of less than 140/90 mm Hg.

Main Outcome Measures  Primary outcome measures were rates of change of glomerular filtration rate and albuminuria during follow-up. Detection of new-onset microalbuminuria and restoration of normal albumin excretion during follow-up were considered as secondary outcomes.

Results  At baseline, glomerular filtration rate and albuminuria were higher in patients with primary aldosteronism than those with essential hypertension. The mean blood pressure during the study was 136/81 mm Hg in the primary aldosteronism group and 137/81 mm Hg in the essential hypertension group. Glomerular filtration rate and albuminuria declined during the initial 6-month period in both groups, with a change that was significantly greater (P<.001 for both variables) in patients with primary aldosteronism. Subsequent rate of decline of glomerular filtration was comparable in the 2 groups, whereas albuminuria did not progress in the remainder of the follow-up. Restoration of normal albumin excretion from microalbuminuria was significantly more frequent in primary aldosteronism than in essential hypertension (P = .02).

Conclusion  In the majority of patients in this study, primary aldosteronism was characterized by partially reversible renal dysfunction in which elevated albuminuria is a marker of a dynamic rather than structural renal defect.

Author Affiliations: Hypertension Unit, Division of Internal Medicine, Department of Experimental and Clinical Pathology and Medicine, University of Udine, Udine, Italy.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Aldosterone in clinical nephrology--old hormone, new questions
Becker et al.
Nephrol Dial Transplant 2009;24:2316-2321.
FULL TEXT  

Intrarenal Hemodynamics in Primary Aldosteronism before and after Treatment
Sechi et al.
J. Clin. Endocrinol. Metab. 2009;94:1191-1197.
ABSTRACT | FULL TEXT  

Cardiovascular and Cerebrovascular Comorbidities of Hypokalemic and Normokalemic Primary Aldosteronism: Results of the German Conn's Registry
Born-Frontsberg et al.
J. Clin. Endocrinol. Metab. 2009;94:1125-1130.
ABSTRACT | FULL TEXT  

Fasting Plasma Glucose and Serum Lipids in Patients With Primary Aldosteronism: A Controlled Cross-Sectional Study
Matrozova et al.
Hypertension 2009;53:605-610.
ABSTRACT | FULL TEXT  

Risk Factors Associated with a Low Glomerular Filtration Rate in Primary Aldosteronism
Reincke et al.
J. Clin. Endocrinol. Metab. 2009;94:869-875.
ABSTRACT | FULL TEXT  

Relation of Dietary Salt and Aldosterone to Urinary Protein Excretion in Subjects With Resistant Hypertension
Pimenta et al.
Hypertension 2008;51:339-344.
ABSTRACT | FULL TEXT  

Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment
Catena et al.
Arch Intern Med 2008;168:80-85.
ABSTRACT | FULL TEXT  

Long-Term Cardiac Effects of Adrenalectomy or Mineralocorticoid Antagonists in Patients With Primary Aldosteronism
Catena et al.
Hypertension 2007;50:911-918.
ABSTRACT | FULL TEXT  

Will the Lessons From Primary Aldosteronism Change the Treatment of Hypertension and Left Ventricular Hypertrophy?
Auchus and Drazner
Hypertension 2007;50:837-839.
FULL TEXT  

Is There an Unrecognized Epidemic of Primary Aldosteronism? (Con)
Kaplan and Calhoun
Hypertension 2007;50:454-458.
FULL TEXT  

Measurement of 18-Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism
Auchus et al.
J. Clin. Endocrinol. Metab. 2007;92:2648-2651.
ABSTRACT | FULL TEXT  

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism
Catena et al.
CJASN 2007;2:722-731.
ABSTRACT | FULL TEXT  

Antagonistic effects of bone morphogenetic protein-4 and -7 on renal mesangial cell proliferation induced by aldosterone through MAPK activation
Otani et al.
Am. J. Physiol. Renal Physiol. 2007;292:F1513-F1525.
ABSTRACT | FULL TEXT  

Primary hyperaldosteronism in a patient with end-stage renal disease
Kazory and Weiner
Nephrol Dial Transplant 2007;22:917-919.
FULL TEXT  

What's new in hypertension?
Mann
Nephrol Dial Transplant 2007;22:47-52.
FULL TEXT  

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Hypertension Due to Primary Aldosteronism: A Case for Exclusion
Bubbar et al.
The Annals of Pharmacotherapy 2007;41:129-132.
ABSTRACT | FULL TEXT  

Renal Function in Primary Aldosteronism
Catena et al.
Hypertension 2006;48:e110-e110.
FULL TEXT  

Response to Renal Function in Primary Aldosteronism: Is Glomerular Hyperfiltration a Hallmark of Primary Aldosteronism? Further Results from the Primary Aldosteronism Prevalence in Hypertension (PAPY) Study
Rossi et al.
Hypertension 2006;48:e111-e112.
FULL TEXT