Relative glomerular hyperfiltration in primary aldosteronism
Relative glomerular hyperfiltration in primary aldosteronism
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DOI：
10.1681/asn.2004100878
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发表时间：
2005-05-01
影响因子：
13.6
通讯作者：
Mimran, A
中科院分区：
文献类型：
--
作者：
Ribstein, J;Du Cailar, G;Mimran, A
实验和临床数据表明，原发性醛固酮增多症（PA）可能与心血管肥大和纤维化有关，部分独立于血压水平。PA是否也可能导致对肾脏的特定有害影响的研究较少。在25例肿瘤性PA患者中，在手术治愈前和手术治愈后6个月进行了肾脏研究（蛋白质尿排泄、GFR和有效肾血浆流量[ERPF]，分别作为锝标记的二亚乙基三氨基五乙酸和I-131-邻碘马尿酸盐的清除率）。对照组为原发性高血压（EH）患者，在降压治疗前和治疗6个月后进行研究。在基线时，PA和EH患者在人口统计学数据、高血压持续时间和水平以及GFR和ERPF方面相似。PA的尿白蛋白和62微球蛋白排泄量高于EH（分别为88 +/- 26 vs 39 +/- 12和0.91 +/- 0.23 vs 0.26 +/- 0.19 mg/24 It;均P < 0.05）。肾上腺切除术后，动脉血压下降（28 ± 3/13 ± 2 mmHg），尿白蛋白和β 2微球蛋白排泄量下降（分别为48 ± 19和0.53 ± 0.21 mg/24 h），GFR和ERPF下降（分别为15 ± 3和54 ± 15 ml/min/1.73 m2）。在高血压患者中，类似的血压下降与蛋白尿减少相关，但GFR或ERPF无变化。在接受6个月螺内酯治疗的25名PA患者中，有17名患者的GFR和ERPF与BP平行下降，与手术后观察到的结果相似。这些数据表明，PA与相对高滤过相关，在抑制醛固酮过量后未被掩盖。
Experimental and clinical data suggest that primary aldosteronism (PA) may be associated with cardiovascular hypertrophy and fibrosis, in part independent of the BP level. Whether PA may also result in specific deleterious effects on the kidneys was less studied. In 25 patients with tumoral PA, renal studies (urinary excretion of proteins, GFR, and effective renal plasma flow [ERPF], as clearances of technetium-labeled diethylene triaminopentaacetic acid and I-131-ortho iodohippurate, respectively) were performed both before and 6 mo after surgical cure. A control group consisting of patients with essential hypertension (EH) was studied before and after 6 mo of antihypertensive therapy. At baseline, PA and EH patients were similar with respect to demographic data, duration and level of hypertension, and GFR and ERPF. Urinary excretion of albumin and 62 microglobulin were higher in PA than EH (88 +/- 26 versus 39 +/- 12 and 0.91 +/- 0.23 versus 0.26 +/- 0.19 mg/24 It, respectively; both P < 0.05). Adrenalectomy was followed by a decrease in arterial BP (by 28 +/- 3/13 +/- 2 mmHg), urinary excretion of albumin and beta 2 microglobulin (by 48 +/- 19 and 0.53 +/- 0.21 mg/24 h, respectively), and GFR and ERPF (by 15 +/- 3 and 54 +/- 15 ml/min per 1.73 m(2), respectively). In EH, a similar decrease in pressure was associated with a decrease in albuminuria but no change in GFR or ERPF. In 17 of the 25 PA patients who received a 6-mo treatment of spironolactone, both GFR and ERPF decreased in parallel with BP, similar to what was observed after surgery. These data suggest that PA was associated with relative hyperfiltration, unmasked after suppression of aldosterone excess.