Unmasking primary aldosteronism after kidney transplantation: a case series

Primary aldosteronism is characterized by excess aldosterone production leading to hypertension and hypokalemia. We report three cases of unilateral primary aldosteronism after kidney transplantation. Each patient presented with elevated blood pressure and hypokalemia early posttransplant. Diagnosis was established through elevated aldosterone-to-renin ratios and positive aldosterone suppression tests, and lateralization was determined with selective adrenal venous sampling. Ipsilateral adrenalectomy improved hypokalemia and blood pressure control for all. Notably, two patients with biopsy-confirmed glomerular pathology after kidney transplantation exhibited proteinuria reduction following adrenalectomy.