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Petramala L, Concistrè A, Circosta F, Gigante A, Sarlo F, Schina M, Soldini M, Iannucci G, Cianci R, Letizia C. Evaluation of Intra-Renal Stiffness in Patients with Primary Aldosteronism. High Blood Press Cardiovasc Prev 2021; 29:49-56. [PMID: 34757582 DOI: 10.1007/s40292-021-00485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
INTORDUCTION Aldosterone is known to play important role in developing cardiovascular, metabolic, renal damage in hypertensive patients. AIM Aim of study was to evaluate parameters obtained by eco-color Doppler study, as non-invasive and easly performed method in asyntomatic patients with Essential Hypertension (EH) and Primary Aldosteronism (PA), without overt organ damage. METHODS From April 2019 to March 2020 we consecutively enrolled 73 hypertensive subjects (48 males, 25 women), distinguished in two groups: 30 EH patients (mean age 49.5 ± 18.7 years) and 43 PA patients (mean age 53.1 ± 11.6 years)] [23 with aldosterone-secreting adrenal adenoma (APA), 20 with idiopathic aldosteronism (IHA)]. RESULTS PA group showed higher renal filtration rate and 24-h urinary excretion of albumin respect to EH; moreover, in PA we found higher Pulsatility Index, altered percentage of Renale Resistance Index, Atrophy Index, and reducted parietal thickness than EH. The correlation study showed that plasma aldosterone were positively correlated with pulsatility index in PA group (right r = 0.35; p < 0.05; left r = 0.36; p < 0.05). CONCLUSION parameters obtained through the intra-renal eco-color Doppler examination, easly performed and non-invasive, can be useful in the early-stage identification of subclinical microvascular alterations, especially in PA, condition characterized by increased risk of cardio-vascular remodelling and metabolic alterations.
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Affiliation(s)
- Luigi Petramala
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Antonio Concistrè
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Francesco Circosta
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Antonietta Gigante
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | | | - Mauro Schina
- Department of Clinical, Intenal Medicine, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Soldini
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Gino Iannucci
- Department of Clinical, Intenal Medicine, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Rosario Cianci
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Claudio Letizia
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy.
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Davis S, Murali KM, Huber D, Lambert K. Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: A retrospective cohort study. Intern Med J 2021; 52:1773-1779. [PMID: 34580977 DOI: 10.1111/imj.15542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Renal resistive index (RRI), which reflects intra-renal arterial impedance is routinely measured when undertaking renal Doppler ultrasonography (RDU). We investigated the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examined whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow-up. METHODS This retrospective observational study examined the association of elevated RRI (>0.7) with the presence of CKD (eGFR <60 mL/min for >3 months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow-up using mixed models. RESULTS Of the 346 patients undergoing RDU (median age 69.7 years, 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = -0.53, -0.51, -0.53, all p < 001). Elevated RRI was independently predicted by older age (Odds Ratio 3.29, 95% CI: 2.25-4.8, p < 0.001) and diabetes (Odds Ratio 2.65, 95% CI: 1.21-5.80, p = 0.015) but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow-up. CONCLUSION Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sarah Davis
- Department of Nephrology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Karumathil M Murali
- Department of Nephrology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - David Huber
- Vascular Care Centre 51 Crown Street, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population, University of Wollongong, Wollongong, New South Wales, Australia
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Ogata H, Yamazaki Y, Tezuka Y, Gao X, Omata K, Ono Y, Kawasaki Y, Tanaka T, Nagano H, Wada N, Oki Y, Ikeya A, Oki K, Takeda Y, Kometani M, Kageyama K, Terui K, Gomez-Sanchez CE, Liu S, Morimoto R, Joh K, Sato H, Miyazaki M, Ito A, Arai Y, Nakamura Y, Ito S, Satoh F, Sasano H. Renal Injuries in Primary Aldosteronism: Quantitative Histopathological Analysis of 19 Patients With Primary Adosteronism. Hypertension 2021; 78:411-421. [PMID: 34120452 DOI: 10.1161/hypertensionaha.121.17436] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Hiroko Ogata
- From the Department of Pathology (H.O., Y.Y., X.G., H. Sasano), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuto Yamazaki
- From the Department of Pathology (H.O., Y.Y., X.G., H. Sasano), Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Clinical Hypertension, Endocrinology and Metabolism (Y. Tezuka, K. Omata, Y. Ono, F.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Tezuka
- Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan.,Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor (Y. Tezuka)
| | - Xin Gao
- From the Department of Pathology (H.O., Y.Y., X.G., H. Sasano), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Omata
- Division of Clinical Hypertension, Endocrinology and Metabolism (Y. Tezuka, K. Omata, Y. Ono, F.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Yoshikiyo Ono
- Division of Clinical Hypertension, Endocrinology and Metabolism (Y. Tezuka, K. Omata, Y. Ono, F.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Yoshihide Kawasaki
- Division of Urology (Y.K., A. Ito, Y.A.), Tohoku University Hospital, Sendai, Japan
| | - Tomoaki Tanaka
- Department of Molecular diagnosis, Chiba University Graduate School of Medicine, Japan (T.T., H.N.)
| | - Hidekazu Nagano
- Department of Molecular diagnosis, Chiba University Graduate School of Medicine, Japan (T.T., H.N.)
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Japan (N.W.)
| | - Yutaka Oki
- Department of Endocrinology and Metabolism, Hamamatsu University School of Medicine, Shizuoka, Japan (Y. Oki, A. Ikeya)
| | - Akira Ikeya
- Department of Endocrinology and Metabolism, Hamamatsu University School of Medicine, Shizuoka, Japan (Y. Oki, A. Ikeya)
| | - Kenji Oki
- Department of Molecular and Internal Medicine, Graduate School of Biochemical and Health Sciences, Hiroshima University Hospital, Japan (K. Oki)
| | - Yoshiyu Takeda
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan (Y. Takeda, M.K.)
| | - Mitsuhiro Kometani
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan (Y. Takeda, M.K.)
| | - Kazunori Kageyama
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan (K.K., K.T.)
| | - Ken Terui
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan (K.K., K.T.)
| | - Celso E Gomez-Sanchez
- Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Center, Jackson (C.E.G.-S.).,Research and Medicine Services, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS (C.E.G.-S.)
| | - Shujun Liu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China (S.L.)
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan (K.J.)
| | - Hiroshi Sato
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Faculty of Pharmaceutical Sciences, Sendai, Japan (H. Sato)
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Akihiro Ito
- Division of Urology (Y.K., A. Ito, Y.A.), Tohoku University Hospital, Sendai, Japan
| | - Yoichi Arai
- Division of Urology (Y.K., A. Ito, Y.A.), Tohoku University Hospital, Sendai, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan (Y.N.)
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Fumitoshi Satoh
- Division of Clinical Hypertension, Endocrinology and Metabolism (Y. Tezuka, K. Omata, Y. Ono, F.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Nephrology, Endocrinology, and Vascular Medicine (Y. Tezuka, K. Omata, Y. Ono, R.M., M.M., S.I., F.S.), Tohoku University Hospital, Sendai, Japan
| | - Hironobu Sasano
- From the Department of Pathology (H.O., Y.Y., X.G., H. Sasano), Tohoku University Graduate School of Medicine, Sendai, Japan
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Jansen PM, Stowasser M. Aldosterone-producing adenoma associated with non-suppressed renin: a case series. J Hum Hypertens 2021; 36:373-380. [PMID: 33785905 DOI: 10.1038/s41371-021-00525-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 11/09/2022]
Abstract
Although the aldosterone/renin ratio (ARR) is the preferred screening test for primary aldosteronism (PA), patients with non-suppressed renin and a falsely negative ARR on non-interfering medications have occasionally been reported. This report describes the clinical characteristics and outcomes of seven patients with proven aldosterone-producing adenoma (APA) and non-suppressed renin.Chart review of seven PA patients with an APA and a non-suppressed plasma renin concentration (PRC > 8.4 mU/L) was undertaken to collect data on anthropometric and biochemical characteristics, diagnostic evaluation and postsurgical outcomes.Seven patients (two women and five men) with a proven APA had median (range) PRC, plasma aldosterone and ARR of 20 (9-43) mU/L, 750 (270-1940) pmol/L and 45 (8-62, normal <70), respectively, on non-interfering medications. Six patients had two consecutive ARR measurements and in five of them both were normal. Renal artery stenosis was carefully excluded in all patients. Further evaluation for PA was pursued because of high clinical suspicion (either hypokalaemia and/or a known adrenal mass lesion on imaging). All underwent adrenal vein sampling confirming unilateral PA which was managed by unilateral adrenalectomy. Postsurgical follow-up data either confirmed or were highly suggestive of cure of PA.Strict control of factors known to influence the ARR is crucial to avoid false-negative results. Other causes that could explain a non-suppressed renin should be excluded. In patients with a consistently non-suppressed renin further diagnostic workup for PA should be considered if clinical suspicion remains high.
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Affiliation(s)
- Pieter Martijn Jansen
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
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Li H, Shen Y, Yu Z, Huang Y, He T, Xiao T, Li Y, Xiong J, Zhao J. Potential Role of the Renal Arterial Resistance Index in the Differential Diagnosis of Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2021; 12:731187. [PMID: 35095752 PMCID: PMC8796316 DOI: 10.3389/fendo.2021.731187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS To investigate the potential role of renal arterial resistance index (RI) in the differential diagnosis between diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) and establish a better-quantified differential diagnostic model. MATERIALS AND METHODS We consecutively reviewed 469 type 2 diabetes patients who underwent renal biopsy in our center. According to the renal biopsy results, eligible patients were classified into the DKD group and the NDKD group. The diagnostic significance of RI was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to search for independent risk factors associated with DKD. Then a novel diagnostic model was established using multivariate logistic regression analysis. RESULTS A total of 332 DKD and 137 NDKD patients were enrolled for analysis. RI was significantly higher in the DKD group compared with those in the NDKD group (0.70 vs. 0.63, p< 0.001). The optimum cutoff value of RI for predicting DKD was 0.66 with sensitivity (69.2%) and specificity (80.9%). Diabetic retinopathy, diabetes duration ≥ 60 months, HbA1c ≥ 7.0(%), RI ≥ 0.66, and body mass index showed statistical significance in the multivariate logistic regression analysis. Then, we constructed a new diagnostic model based on these results. And the validation tests indicated that the new model had good sensitivity (81.5%) and specificity (78.6%). CONCLUSIONS RI has a potential role in discriminating DKD from NDKD. The RI-based predicting model can be helpful for differential diagnosis of DKD and NDKD.
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Satoh F, Ito S, Itoh H, Rakugi H, Shibata H, Ichihara A, Omura M, Takahashi K, Okuda Y, Iijima S. Efficacy and safety of esaxerenone (CS-3150), a newly available nonsteroidal mineralocorticoid receptor blocker, in hypertensive patients with primary aldosteronism. Hypertens Res 2020; 44:464-472. [PMID: 33199881 PMCID: PMC8019657 DOI: 10.1038/s41440-020-00570-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/09/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023]
Abstract
Mineralocorticoid receptor (MR) blockers are very beneficial for patients with hypertension and primary aldosteronism (PA). We investigated the efficacy and safety of a newly available nonsteroidal MR blocker, esaxerenone, in Japanese patients with hypertension and PA. A multicenter, open-label study was conducted in Japan between October 2016 and July 2017. Patients with hypertension and PA received 12 weeks of treatment with esaxerenone, initiated at 2.5 mg/day and escalated to 5 mg/day during week 2 or 4 of treatment, based on individual response. The only other permitted antihypertensive therapies were stable dosages of a Ca2+ channel blocker or α-blocker. The primary efficacy outcome was a change in sitting systolic and diastolic blood pressure (SBP/DBP) from baseline to the end of treatment. Forty-four patients were included; dose escalation to 5 mg/day was implemented for 41 of these patients. Significant decreases in SBP and DBP were observed (point estimates [95% confidence interval] −17.7 [−20.6, −14.7] and −9.5 [−11.7, −7.3] mmHg, respectively; both p < 0.0001 at the end of treatment). Significant BP reductions were evident from week 2 and continued through to week 8; BP remained stable until week 12. The antihypertensive effect of esaxerenone on SBP was significantly greater in females and in patients receiving monotherapy. The major drug-related adverse events were serum K+ increase and estimated glomerular filtration rate decrease (both 4.5%, n = 2); no gynecomastia or breast pain was observed. We conclude that esaxerenone is a potent MR blocker with favorable efficacy and safety profiles in patients with hypertension and PA.
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Affiliation(s)
- Fumitoshi Satoh
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Katta General Hospital, 36 Shimoharaoki, Fukuokakuramoto, Shiroishi, Miyagi, 989-0231, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masao Omura
- Minatomirai Medical Square, 3-6-3 Minatomirai, Nishi-ku, Yokohama, 220-0012, Japan
| | | | - Yasuyuki Okuda
- Daiichi Sankyo Co., Ltd, 1-2-58 Hiromachi, Shinagawa-ku, Tokyo, 140-8710, Japan
| | - Setsuko Iijima
- Daiichi Sankyo Co., Ltd, 1-2-58 Hiromachi, Shinagawa-ku, Tokyo, 140-8710, Japan
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Watanabe I, Shintani Y, Terada S, Fujii T, Kiuchi S, Nakanishi R, Katayanagi T, Kawasaki M, Tokuhiro K, Ohsawa H, Ikeda T. A Clinical Association between an Increasing Renal Resistive Index and the Atherosclerotic Burden in Patients with a Preserved Renal Function. Intern Med 2020; 59:909-916. [PMID: 32238661 PMCID: PMC7184073 DOI: 10.2169/internalmedicine.3232-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective A positive correlation is observed between the progression of renal impairment and the increasing risk of cardiovascular disease. Our aim was to examine the relationship between the renal resistive index (RRI) assessed by duplex sonography and the extent of atherosclerosis in patients without renal impairment undergoing vascular imaging studies. Methods The RRI was evaluated pre-procedurally among 106 outpatients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 undergoing clinically-driven coronary computed tomography angiography (CCTA). In those subjects, a carotid artery ultrasound scan was also performed to evaluate carotid artery disease. We investigated the association between the RRI and the atherosclerotic extent, defined by the presence of coronary artery calcium (CAC) >0 and carotid intima-media thickness (cIMT) ≥1.0 mm. Results Multi-site atherosclerosis (CAC>0 and cIMT≥1.0 mm) was found in 31 patients. The RRI was significantly increased with an increasing number of atherosclerotic vessels (absence of atherosclerosis: 0.65±0.04 vs. single-site atherosclerosis: 0.67±0.06 vs. multi-site atherosclerosis: 0.71±0.05, p<0.001). A multivariate logistic regression analysis showed that RRI>0.70 [odds ratio (OR): 4.05, 95% confidence interval (CI), 1.37-12.0, p=0.01], cardio ankle vascular index (CAVI) ≥9.0 (OR: 8.18, 95% CI: 2.47-27.1, p<0.01), diabetes (OR: 4.34, 95% CI: 1.37-13.7, p=0.01) and an eGFR>90 mL/min/1.73 m2 (OR: 5.89, 95% CI: 1.39-25.1, p=0.01) were associated with multi-site atherosclerosis. Conclusion The RRI, a sub-clinical renal parameter is an atherosclerotic marker in patients without renal impairment.
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Affiliation(s)
- Ippei Watanabe
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Yodo Shintani
- Cardiovascular Centre of Misato Central General Hospital, Japan
| | | | - Takahiro Fujii
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | | | | | | | - Hidefumi Ohsawa
- Cardiovascular Centre of Misato Central General Hospital, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
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Kitamoto T, Omura M, Suematsu S, Saito J, Nishikawa T. KCNJ5 mutation as a predictor for resolution of hypertension after surgical treatment of aldosterone-producing adenoma. J Hypertens 2018; 36:619-27. [PMID: 29016532 DOI: 10.1097/HJH.0000000000001578] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of KCNJ5 mutations on the cure of hypertension in patients with aldosterone-producing adenoma (APA) after unilateral adrenalectomy. METHODS Our study included 142 patients with APA, who were detected with an endocrinological abnormality and diagnosed with hypertension, as confirmed by pathological analysis. We sequenced KCNJ5, ATP1A1, ATP2B3, CACNA1D, and CTNNB1 from APA tissue samples, and performed a retrospective analysis to determine correlations between wild-type or mutated KCNJ5 and patient clinical characteristics. RESULTS Somatic KCNJ5 mutations were identified in 106 of 142 patients with APA, 136 of whom had resolution of hyporeninemic-hyperaldosteronemia 1 year after surgery. Of the 136 patients, 81 patients had resolution of hypertension ('Cured group' vs. 'Improved group'). We found increased prevalence of KCNJ5 mutations in the Cured group compared to the Improved group (85.2% vs. 60.0%, respectively; P = 0.002), which was associated with younger age, shorter duration of hypertension, fewer antihypertensive medications, lower BMI, higher aldosterone level, higher estimated glomerular filtration rate, and milder vascular complications. In both groups we found that harbouring a KCNJ5 mutation, taking fewer antihypertensive medications, and the duration of hypertension were independently associated with resolution of hypertension by unilateral adrenalectomy. In patients with KCNJ5-mutated APA, left ventricular hypertrophy was significantly decreased by surgical treatment in patients from either Cured or Improved groups, although those patients with wild-type KCNJ5 showed no change. CONCLUSIONS Testing for KCNJ5 mutations in young patients with APA may provide a prognostic indication for resolution of hypertension and severity of vascular complications.
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Okamoto R, Taniguchi M, Onishi Y, Kumagai N, Uraki J, Fujimoto N, Fujii E, Yano Y, Ogura T, Ito M. Predictors of confirmatory test results for the diagnosis of primary hyperaldosteronism in hypertensive patients with an aldosterone-to-renin ratio greater than 20. The SHRIMP study. Hypertens Res 2019; 42:40-51. [PMID: 30401909 DOI: 10.1038/s41440-018-0126-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/04/2018] [Accepted: 06/25/2018] [Indexed: 11/08/2022]
Abstract
It remains unknown which surrogate markers can predict diagnostic test results for primary hyperaldosteronism (PA). The Secondary Hypertension Registry Investigation in Mie Prefecture (SHRIMP) study has sequentially and prospectively recruited 128 patients with hypertension with an aldosterone-to-renin ratio (ARR) greater than 20, evaluated the differences among essential hypertension (EHT), idiopathic hyperaldosteronism (IHA), and aldosterone-producing adenoma (APA), and analyzed the predictors for the confirmatory tests. The patients underwent saline-loading, captopril-challenge, and upright furosemide-loading tests. Carotid, renovascular, and cardiac echography, brachial ankle pulse wave velocity (baPWV), endothelial function, nocturnal blood pressure decline, and the apnea hypopnea index were evaluated. Multivariate regression analyses showed that the plasma aldosterone concentration (PAC) at screening was a strong predictor of the saline and captopril test results. The plasma renin activity (PRA) at screening, urine β2-microglobulin, and left ventricular mass index (LVMI) were independent predictors for the captopril test. The estimated saline PAC and captopril 60 and 90 min ARRs predicted by the equations were highly correlated with the real values. The ROC curve analysis showed PAC at screening among each of predictors for the diagnostic tests and PAC after the saline-loading test had the highest diagnostic abilities of APA. Patients with IHA were older and had glucose intolerance and increased U-Alb/gCre and resistive indices. In patients with APA, the levels of U-Alb/gCre and urine β2-microglobulin were increased, and levels of insulin and the HOMA-IR were decreased. In conclusion, our proposed equations may be useful for estimating saline PAC and captopril ARR. Diagnostic predictors may differ for each confirmatory test.
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Andrikou I, Tsioufis C, Konstantinidis D, Kasiakogias A, Dimitriadis K, Leontsinis I, Andrikou E, Sanidas E, Kallikazaros I, Tousoulis D. Renal resistive index in hypertensive patients. J Clin Hypertens (Greenwich) 2018; 20:1739-1744. [PMID: 30362245 DOI: 10.1111/jch.13410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/16/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
Spectral Doppler ultrasonography provides the evaluation of renal resistive index (RRI), a noninvasive and reproducible measure to investigate arterial compliance and/or resistance. RRI seems to possess an important role in the evaluation of diverse cases of secondary hypertension. In essential hypertension, RRI is associated with subclinical markers of target organ damage and reflects renal disease progression beyond albuminuria and creatinine clearance. Also, RRI can estimate cardiovascular and renal risk. The evaluation of RRI may also help the therapeutic decisions. Given its simple assessment, RRI emerges as a simple method and a "multifunctional" tool that could help on the cardiovascular risk evaluation of the hypertensive patient.
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Affiliation(s)
- Ioannis Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eirini Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Sanidas
- Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | | | - Dimitris Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Abstract
Primary aldosteronism (PA) is now considered as one of leading causes of secondary hypertension, accounting for 5-10% of all hypertensive patients and more strikingly 20% of those with resistant hypertension. Importantly, those with the unilateral disease could be surgically cured when diagnosed appropriately. On the other hand, only a very limited portion of those suspected to have PA has been screened, diagnosed, or treated to date. With current advancement in medical technologies and genetic research, expanding knowledge of PA has been accumulated and recent achievements have also been documented in the care of those with PA. This review is aimed to have focused description on updated topics of the following; importance of PA screening both in the general and specialized settings and careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance, and expanding knowledge on PA genetics. Improvement in workup processes and novel treatment options, as well as better understanding of the PA pathogenesis based on genetic research, might be expected to result in increased cure and better care of the patients.
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Affiliation(s)
- Ryo Morimoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kei Omata
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Abstract
Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident <age 40, and first-degree relatives of patients with primary aldosteronism. Clinical and laboratory methods of screening, confirmatory testing, subtype classification, and medical and surgical management are systematically reviewed and illustrated with a clinical case.
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Morimoto R, Ono Y, Tezuka Y, Kudo M, Yamamoto S, Arai T, Gomez-Sanchez CE, Sasano H, Ito S, Satoh F. Rapid Screening of Primary Aldosteronism by a Novel Chemiluminescent Immunoassay. Hypertension 2017; 70:334-341. [PMID: 28652474 DOI: 10.1161/hypertensionaha.117.09078] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/01/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
Measurement of plasma aldosterone and renin concentration, or activity, is useful for selecting antihypertensive agents and detecting hyperaldosteronism in hypertensive patients. However, it takes several days to get results when measured by radioimmunoassay and development of more rapid assays has been long expected. We have developed chemiluminescent enzyme immunoassays enabling the simultaneous measurement of both aldosterone and renin concentrations in 10 minutes by a fully automated assay using antibody-immobilized magnetic particles with quick aggregation and dispersion. We performed clinical validation of diagnostic ability of this newly developed assay-based screening of 125 patients with primary aldosteronism from 97 patients with essential hypertension. Results of this novel assay significantly correlated with the results of radioimmunoassay (aldosterone, active renin concentration, and renin activity) and liquid chromatography-tandem mass spectrometry (aldosterone). The analytic sensitivity of this particularly novel active renin assay was 0.1 pg/mL, which was better than that of radioimmunoassay (2.0 pg/mL). The ratio of aldosterone-to-renin concentrations of 6.0 (ng/dL per pg/mL) provided 92.0% sensitivity and 76.3% specificity as a cutoff for differentiating primary aldosteronism from essential hypertension. This novel measurement is expected to be a clinically reliable alternative for conventional radioimmunoassay and to provide better throughput and cost effectiveness in diagnosis of hyperaldosteronism from larger numbers of hypertensive patients in clinical settings.
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Affiliation(s)
- Ryo Morimoto
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Yoshikiyo Ono
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Yuta Tezuka
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Masataka Kudo
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Sachiko Yamamoto
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Toshiaki Arai
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Celso E Gomez-Sanchez
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Hironobu Sasano
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Sadayoshi Ito
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Fumitoshi Satoh
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.).
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Lai S, Petramala L, Mastroluca D, Petraglia E, Di Gaeta A, Indino E, Panebianco V, Ciccariello M, Shahabadi HH, Galani A, Letizia C, D’Angelo AR. Hyperaldosteronism and cardiovascular risk in patients with autosomal dominant polycystic kidney disease. Medicine (Baltimore) 2016; 95:e4175. [PMID: 27442639 PMCID: PMC5265756 DOI: 10.1097/md.0000000000004175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/04/2016] [Accepted: 06/14/2016] [Indexed: 01/22/2023] Open
Abstract
Hypertension is commonly associated with autosomal dominant polycystic kidney disease (ADPKD), often discovered before the onset of renal failure, albeit the pathogenetic mechanisms are not well elucidated. Hyperaldosteronism in ADPKD may contribute to the development of insulin resistance and endothelial dysfunction, and progression of cardiorenal disease. The aim of study was to evaluate the prevalence of primary aldosteronism (PA) in ADPKD patients and identify some surrogate biomarkers of cardiovascular risk.We have enrolled 27 hypertensive ADPKD patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, evaluating the renin-angiotensin-aldosterone system (RAAS), inflammatory indexes, nutritional status, homocysteine (Hcy), homeostasis model assessment-insulin resistance (HOMA-IR), mineral metabolism, microalbuminuria, and surrogate markers of atherosclerosis [carotid intima media thickness (cIMT), ankle/brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI) and left ventricular mass index (LVMI)]. Furthermore, we have carried out the morpho-functional magnetic resonance imaging (MRI) with high-field 3 T Magnetom Avanto.We have divided patients into group A, with normal plasma aldosterone concentration (PAC) and group B with PA, present in 9 (33%) of overall ADPKD patients. Respect to group A, group B showed a significant higher mean value of LVMI, HOMA-IR and Hcy (P = 0.001, P = 0.004, P = 0.018; respectively), and a lower value of FMD and 25-hydroxyvitamin D (25-OH-VitD) (P = 0.037, P = 0.019; respectively) with a higher prevalence of non-dipper pattern at Ambulatory Blood Pressure Monitoring (ABPM) (65% vs 40%, P < 0.05) at an early stage of the disease.In this study, we showed a high prevalence of PA in ADPKD patients, associated to higher LVMI, HOMA-IR, Hcy, lower FMD, and 25-OH-VitD, considered as surrogate markers of atherosclerosis, compared to ADPKD patients with normal PAC values. Our results indicate a higher overall cardiovascular risk in ADPKD patients with inappropriate aldosterone secretion, and a screening for PA in all patients with ADPKD is recommended.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Sapienza University of Rome, Rome
| | - Luigi Petramala
- Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome
| | - Daniela Mastroluca
- Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome
| | | | - Alessandro Di Gaeta
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome
| | - Elena Indino
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome
| | - Mauro Ciccariello
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome
| | - Hossein H. Shahabadi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Claudio Letizia
- Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome
| | - Anna Rita D’Angelo
- Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
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