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Changes in kidney function after adrenalectomy in patients with primary aldosteronism
Yumi Tomiie1, Yatsuka Hibi1, Rie Nobe1,2
1Department of Endocrine Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Fujita Medical Journal
|February 3, 2025
Summary
A decrease in estimated glomerular filtration rate (eGFR) after adrenalectomy for primary aldosteronism (PA) is common. This kidney dysfunction is unmasked by surgery, with hypertension and low potassium predicting the drop.
Area of Science:
- Nephrology
- Endocrinology
- Surgical Oncology
Background:
- Primary aldosteronism (PA) can mask kidney dysfunction.
- Adrenalectomy for PA may reveal underlying kidney issues.
- Estimated glomerular filtration rate (eGFR) changes post-adrenalectomy require investigation.
Purpose of the Study:
- To evaluate kidney dysfunction unmasked by adrenalectomy in PA patients.
- To investigate changes in eGFR after adrenalectomy using the "a certain drop in eGFR" guideline.
- To identify predictors of eGFR decline post-adrenalectomy.
Main Methods:
- Retrospective study of 54 PA patients undergoing unilateral adrenalectomy.
- Classification of patients into GFR categories based on pre- and postoperative eGFR.
- Multivariate regression analysis to identify predictors of a significant eGFR drop (≥25% decrease).
Main Results:
- 35.2% of patients experienced a significant eGFR drop post-adrenalectomy.
- Predictors included longer hypertension duration and lower preoperative serum potassium.
- A preoperative serum potassium level of 3.7 mmol/L was a significant cut-off value.
Conclusions:
- Post-adrenalectomy eGFR decline in PA patients is a recognized phenomenon.
- Hypertension duration and preoperative potassium levels are key predictors.
- Findings aid surgeons in patient counseling regarding potential GFR category changes.
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