Changes in kidney function after adrenalectomy in patients with primary aldosteronism
Objectives: A decrease in the estimated glomerular filtration rate (eGFR) is occasionally observed in patients with primary aldosteronism (PA) after adrenalectomy. Patients may misunderstand that the surgical stress of adrenalectomy can result in kidney dysfunction. However, this finding is consid...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Fujita Medical Society
2025-02-01
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| Series: | Fujita Medical Journal |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/fmj/11/1/11_2024-011/_pdf/-char/ja |
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| Summary: | Objectives: A decrease in the estimated glomerular filtration rate (eGFR) is occasionally observed in patients with
primary aldosteronism (PA) after adrenalectomy. Patients may misunderstand that the surgical stress of
adrenalectomy can result in kidney dysfunction. However, this finding is considered due to postoperative
manifestations of kidney dysfunction that are masked preoperatively by excess aldosterone. To evaluate kidney
dysfunction unmasked by adrenalectomy, we investigated changes in the eGFR after adrenalectomy according to
the clinically assessable indication of “a certain drop in eGFR” as defined by the 2012 Kidney Disease Improving
Global Outcomes clinical practice guideline.
Methods: This study included 54 patients with PA who underwent unilateral adrenalectomy between 2005 and 2022
at our institution. We classified patients by GFR categories defined by the guideline according to their pre- and
postoperative eGFR. We analyzed the predictors associated with a certain drop in eGFR (i.e., a decrease in GFR
category accompanied by a ≥25% decrease in the eGFR from baseline).
Results: A certain drop in eGFR was present in 35.2% of patients after adrenalectomy. Multivariate regression
analysis showed that a longer duration of hypertension, lower preoperative serum potassium concentrations, and
lower serum potassium concentrations before potassium supplementation were significant independent predictors
(p<0.05). The cut-off value of the preoperative serum potassium concentrations was 3.7 mmol/L according to
receiver operating characteristic curve analysis.
Conclusions: Our findings will be useful for surgeons in informing patients with PA regarding the possibility of
downgrading GFR categories after adrenalectomy. |
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| ISSN: | 2189-7247 2189-7255 |