AI Article Synopsis

  • Primary aldosteronism (PA) affects 5-18% of hypertensive patients and can be treated effectively with adrenalectomy, especially for those with unilateral PA.
  • A cohort study of 100 patients post-adrenalectomy found that classical PA patients showed higher rates of elevated serum uric acid (SUA) and significant reductions in estimated glomerular filtration rate (eGFR) compared to nonclassical patients.
  • The findings suggest that those with classical PA experience more complications like post-adrenalectomy hyperuricemia (PAHU) and decreased vessel stiffness, highlighting the need for ongoing monitoring of uric acid and kidney function post-surgery.

Article Abstract

Background: Primary aldosteronism (PA), which is present in 5-18% of hypertensive patients, is a leading cause of secondary hypertension. Adrenalectomy is often recommended for patients with unilateral primary aldosteronism (uPA), yielding good long-term outcomes. PA patients without hyperuricemia and chronic renal failure before adrenalectomy were enrolled in this cohort study. Serum uric acid (SUA) and renal filtration were measured one year post-adrenalectomy. Their relationships with pathologic features, histopathological subtype (classical or nonclassical (HISTALDO consensus)), and vessel stiffness were explored. The aim of this cohort study is to evaluate the correlation between post-adrenalectomy serum uric acid (SUA) levels and estimated glomerular filtration rate (eGFR) with the pathologic features delineated by the HISTALDO consensus. Additionally, the study seeks to assess the impact of these biochemical markers on peripheral vessel stiffness and brachial-ankle pulse wave velocity (baPWV) at a one-year follow-up visit.

Methods: This prospective cohort study included patients (N = 100) diagnosed with uPA who underwent adrenalectomy from Jan 1, 2007 to Dec 31, 2022.

Results: At follow-up, elevated SUA, hyperuricemia, and a > 25% eGFR decrease were significantly more common in the classical than the nonclassical group. The incidence of postoperative hyperuricemia, herein referred to as post-adrenalectomy hyperuricemia (PAHU), was 29% (29/100) overall, 34.8% (23/66) in the classical group and 17.6% (6/34) in the nonclassical group. The incidence of eGFR reduction > 25% was 33% (33/100), 43.9% (29/66), and 11.8% (4/34), respectively. baPWV decreased more in the classical group than the nonclassical group.

Conclusion: For PA patients with PAHU and/or renal impairment, we suggest monitoring SUA, pH, urine uric acid, and urine crystals and performing a KUB study and peripheral vascular and renal sonography (on which pure uric acid stones in the KUB are radiolucent) to determine whether drug intervention is required for cases of asymptomatic PAHU, especially patients in male gender, classical histopathology, or renal impairment.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472553PMC
http://dx.doi.org/10.1186/s12882-024-03750-4DOI Listing

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