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Queiroz NL, Stumpf MAM, Souza VCM, Maciel AAW, Fagundes GFC, Okubo J, Srougi V, Tanno FY, Chambo JL, Pereira MAA, Pio-Abreu A, Bortolotto LA, Latronico AC, Barisson Villares Fragoso MC, Drager LF, Mendonça BB, Almeida MQ. Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism. Horm Metab Res 2024; 56:350-357. [PMID: 38040032 DOI: 10.1055/a-2221-3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
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). Our aim was 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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Affiliation(s)
- Nara L Queiroz
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Matheo A M Stumpf
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Victor C M Souza
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Ana Alice W Maciel
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Gustavo F C Fagundes
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Jessica Okubo
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Victor Srougi
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Fabio Y Tanno
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Jose L Chambo
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Maria Adelaide A Pereira
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Andrea Pio-Abreu
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Ana Claudia Latronico
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Adrenal & Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Berenice B Mendonça
- Unidade de Adrenal & Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Madson Q Almeida
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
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Mohib O, Vanderhulst J, Catalano C, Roussoulières A, Knoop C, Lemoine A, Baudoux T. Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients. Cureus 2024; 16:e55379. [PMID: 38434606 PMCID: PMC10908377 DOI: 10.7759/cureus.55379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 03/05/2024] Open
Abstract
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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Affiliation(s)
- Othmane Mohib
- Department of Nephrology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
| | - Julien Vanderhulst
- Internal Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Brussels, BEL
| | - Concetta Catalano
- Department of Nephrology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
| | - Ana Roussoulières
- Department of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
| | - Christiane Knoop
- Department of Pulmonology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
| | - Alain Lemoine
- Department of Nephrology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
| | - Thomas Baudoux
- Department of Nephrology, Cliniques Universitaires de Bruxelles - Hôpital (CUB) Erasme, Brussels, BEL
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Sawyer N, Glendenning P, Vasikaran SD, Page MM, van Schie G, Wong SL, Yang J, Schlaich MP, Bell DA. The adrenal vein sampling outcomes study (AVOS): success rates following adrenalectomy for unilateral primary aldosteronism. Pathology 2023; 55:531-537. [PMID: 37062662 DOI: 10.1016/j.pathol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 04/18/2023]
Abstract
The objective was to determine the clinical and biochemical success rates and assess the nature of follow-up after adrenalectomy in patients with unilateral primary aldosteronism (PA), subtyped by adrenal vein sampling (AVS) in West Australia (WA) using the Primary Aldosteronism Surgical Outcome (PASO) criteria. Clinical and biochemical outcomes were retrospectively evaluated in patients with unilateral PA who underwent adrenalectomy according to AVS between September 2017 and September 2020. Pre- and post-surgical data were collected using a standardised questionnaire, review of clinic letters and examination of private and public pathology results and radiological reports. Follow-up data were available for 47 patients post-adrenalectomy; biochemical outcome data were available for 37 patients, clinical outcome data for 40 patients, with 30 patients having both outcomes available. Final assessment was performed between 0 to 3 months in 23/37 (62.2%) patients with biochemical outcomes, 15/40 (37.5%) with clinical outcomes, and 17/30 (56.7%) with both clinical and biochemical outcomes. Complete biochemical success was achieved in 83.8% (31/37) of patients, with 26.7% (8/30) obtaining both complete clinical and biochemical success. Complete clinical success was achieved in 35.0% (14/40) of patients, with 47.5% (19/40) obtaining partial clinical success. Overall, 93.6% (44/47) of patients derived benefit from adrenalectomy. The outcomes of adrenalectomy for unilateral PA in Western Australian using standardised PASO criteria demonstrate highly comparable clinical and biochemical success rates to international data. However, further standardisation of post-operative follow-up care needs to be implemented to ensure the recommended repeat follow-up assessment criteria are collected.
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Affiliation(s)
- Nicola Sawyer
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia
| | - Paul Glendenning
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - Samuel D Vasikaran
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia
| | - Michael M Page
- Medical School, University of Western Australia, Perth, WA, Australia; Western Diagnostic Pathology, Perth, WA, Australia
| | - Greg van Schie
- Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Sze Ling Wong
- Department of Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Jun Yang
- Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia; Department of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Damon A Bell
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia; Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia.
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