Renal damage in primary aldosteronism - Results of the PAPY study
Renal damage in primary aldosteronism - Results of the PAPY study
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DOI：
10.1161/01.hyp.0000230444.01215.6a
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发表时间：
2006-08-01
期刊：
影响因子：
8.3
通讯作者：
Mantero, Franco
中科院分区：
文献类型：
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作者：
Rossi, Gian Paolo;Bernini, Giampaolo;Mantero, Franco
原发性醛固酮增多症（PA）与心血管肥大和纤维化有关，部分独立于血压水平，但对肾脏的有害影响尚不清楚。同样，由醛固酮生成腺瘤（APA）和特发性醛固酮增多症（1HA）引起的PA是否与肾脏有不同的关系，目前尚不清楚。因此，在意大利原发性醛固酮增多症患病率（PAPY）研究中，一项对全国高血压中心新诊断的连续患者进行的前瞻性调查，我们寻找PA患者和原发性高血压（PH）患者肾脏损害的迹象。患者（n=1180）接受了预先确定的筛查方案，随后进行了确认PA和确定潜在肾上腺皮质病理的测试。通过24小时尿白蛋白排泄率（UAE）和肾小球滤过率（GFR）评估肾损害。测量490例患者的UAE率；GFR均正常。其中APA 31例（6.4%），IHA 33例（6.7%），ph为86.9%。体重指数、年龄、尿钠+排泄量、血清钾+、平均血压预测UAE发生率（P < 0.001）。经协变量调整后，APA和IHA患者的UAE率显著高于PH患者；APA组和IHA组微量白蛋白尿患者多于PH组（P=0.007）。在GFR保存的高血压患者中，APA或IHA患者的UAE率高于同类PH患者。因此，由于自主醛固酮分泌过多而引起的高血压比PH更早、更突出地表现为肾损害。
Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (1HA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH). Patients (n=1180) underwent a predefined screening protocol followed by tests for confirming PA and identifying the underlying adrenocortical pathology. Renal damage was assessed by 24-hour urine albumin excretion (UAE) rate and glomerular filtration rate (GFR). UAE rate was measured in 490 patients; all had a normal GFR. Of them, 31 (6.4%) had APA, 33 (6.7%) had IHA, and the rest (86.9%) had PH. UAE rate was predicted (P < 0.001) by body mass index, age, urinary Na+ excretion, serum K+, and mean blood pressure. Covariate-adjusted UAE rate was significantly higher in APA and IHA than in PH patients; there were more patients with microalbuminuria in the APA and IHA than in the PH group (P=0.007). Among the hypertensive patients with a preserved GFR, those with APA or IHA have a higher UAE rate than comparable PH patients. Thus, hypertension because of excess autonomous aldosterone secretion features an early and more prominent renal damage than PH.