A Clinical Prediction Score to Diagnose Unilateral Primary Aldosteronism

Abstract Context: Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available. Objective: Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery. Design and Setting: A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care. Patients: A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test. Intervention: Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling. Main Outcome Measures: Variables independently associated with a lateralized adrenal venous sampling in multivariate logistic regression were used to derive a clinical prediction rule. Results: Adrenal venous sampling was successful in 87 patients and lateralized in 49. All 26 patients with a typical Conn's adenoma plus serum potassium of less than 3.5 mmol/liter or estimated glomerular filtration rate of at least 100 ml/min/1.73 m2 (or both) had unilateral primary aldosteronism; this rule had 100% specificity (95% confidence interval, 91–100) and 53% sensitivity (95% confidence interval, 38–68). Conclusions: If our results are validated on an independent sample, adrenal venous sampling could be omitted before surgery in patients with a typical Conn's adenoma if they meet at least one of two supplementary biochemical characteristics (serum potassium <3.5 mmol/liter or estimated glomerular filtration rate ≥100 ml/min/1.73 m2).

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Age Below 40 or a Recently Proposed Clinical Prediction Score Cannot Bypass Adrenal Venous Sampling in Primary Aldosteronism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-3789 ◽

2014 ◽

Vol 99 (6) ◽

pp. E1035-E1039 ◽

Cited By ~ 54

Author(s):

Anna Riester ◽

Evelyn Fischer ◽

Christoph Degenhart ◽

Maximilian F. Reiser ◽

Martin Bidlingmaier ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Serum Potassium ◽

Primary Aldosteronism ◽

Filtration Rate ◽

Prediction Score ◽

Adrenal Venous Sampling ◽

Young Cohort ◽

Clinical Prediction ◽

Venous Sampling

Context: Adrenal venous sampling (AVS) is used to distinguish bilateral from unilateral primary aldosteronism (PA). Due to its limited availability, clinical prediction scores have been proposed to diagnose unilateral disease without AVS. Objective: Our goal was to test 2 recently proposed predictors of unilateral PA: 1) a clinical prediction score using imaging, serum potassium, and glomerular filtration rate and 2) the combination of visible unilateral adenoma on imaging and age <40 years. Design and Setting: We used the data of all patients with PA of the prospective German Conn's Registry treated in Munich and Berlin since 2008. Patients and Intervention: Of 205 patients with PA, 194 had a successful AVS and were included. Main Outcome Measures: Parameters were compared between patients with lateralized and nonlateralized AVS. Specificity and sensitivity of the proposed predictors were calculated. Results: A total of 130 patients (67%) had unilateral PA according to AVS. Patients with unilateral PA showed a significantly lower estimated glomerular filtration rate compared with patients with bilateral disease (P < .05). The cohorts differed significantly in potassium supplementation, serum potassium, baseline and post-saline plasma aldosterone, baseline aldosterone to renin ratio, and adenoma in imaging. The proposed prediction score had a sensitivity of 46% (58 of 127) and a specificity of 80% (53 of 66). In patients below 40 years (n = 28), the prediction score achieved a specificity of 100%; however, relying only on imaging in this young cohort, the specificity dropped to 83%. Conclusions: The suggested prediction score has high accuracy only in young patients but cannot substitute for AVS in the elderly.

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U-shaped relationship between left ventricular mass index and estimated glomerular filtration rate in patients with primary aldosteronism

Journal of Investigative Medicine ◽

10.1136/jim-2019-001057 ◽

2019 ◽

Vol 68 (2) ◽

pp. 371-377

Author(s):

Min-Tsun Liao ◽

Che-Wei Liao ◽

Cheng-Hsuan Tsai ◽

Yi-Yao Chang ◽

Zheng-Wei Chen ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Left Ventricular Mass ◽

Primary Aldosteronism ◽

Filtration Rate ◽

Left Ventricular Mass Index ◽

Estimated Glomerular Filtration Rate ◽

Left Ventricular ◽

Ventricular Mass Index ◽

Ventricular Mass

Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=−0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=−0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m2, from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH.

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Association Between Acute Fall in Estimated Glomerular Filtration Rate After Treatment for Primary Aldosteronism and Long-Term Decline in Renal Function

Hypertension ◽

10.1161/hypertensionaha.119.13131 ◽

2019 ◽

Vol 74 (3) ◽

pp. 630-638 ◽

Cited By ~ 4

Author(s):

Hiroki Kobayashi ◽

Masanori Abe ◽

Yoshihiro Nakamura ◽

Katsutoshi Takahashi ◽

Megumi Fujita ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Primary Aldosteronism ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate

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The decline in estimated glomerular filtration rate over the course of surgical and medical treatments in patients with primary aldosteronism

European Urology Supplements ◽

10.1016/s1569-9056(19)30726-2 ◽

2019 ◽

Vol 18 (1) ◽

pp. e1000-e1001

Author(s):

T. Ujike ◽

M. Uemura ◽

K. Takezawa ◽

T. Kato ◽

A. Kawashima ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Primary Aldosteronism ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Medical Treatments

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Association of Alcohol Consumption with the Incidence of Proteinuria and Chronic Kidney Disease: A Retrospective Cohort Study in Japan

10.21203/rs.3.rs-965168/v1 ◽

2021 ◽

Author(s):

Akio Tanaka ◽

Makoto Yamaguchi ◽

Takuji Ishimoto ◽

Takayuki Katsuno ◽

Hironobu Nobata ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Glomerular Filtration Rate ◽

Alcohol Consumption ◽

Kidney Disease ◽

Confidence Interval ◽

Glomerular Filtration ◽

Retrospective Cohort ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate

Abstract Background The difference in the clinical impact of alcohol consumption on kidney function based on sex remains to be elucidated. This study aimed to assess the association between the dose of alcohol consumption and the incidence of proteinuria and chronic kidney disease stratified by sex. Methods This retrospective cohort study included 26,788 workers (19,702 men and 7086 women) with normal renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2) at annual health examinations between January 2010 and March 2015 in Japan. The main exposure was alcohol consumption. The primary outcomes were the incidence of proteinuria (dipstick urinary protein ≥1) and incidence of chronic kidney disease (an estimated glomerular filtration rate <60 mL/min per 1.73 m2 and a 25% decrease from the baseline estimated glomerular filtration rate). Results During a median observational period of 4 years (interquartile range: 2–6), 1993 (10.1%) men and 462 (6.5%) women developed proteinuria, whereas 667 (3.4%) men and 255 (3.6%) women developed chronic kidney disease. After adjustment for clinically relevant factors using a Cox proportional hazards model, alcohol consumption of ≥40 g/day in females was significantly associated with the incidence of proteinuria (hazard ratio, 1.65; 95% confidence interval, 1.09–2.51) and chronic kidney disease (hazard ratio, 1.77; 95% confidence interval, 1.09–2.85). However, no significant association between alcohol consumption and primary outcomes was observed in men. Conclusions In conclusion, daily higher alcohol consumption was significantly associated with a higher incidence of proteinuria and chronic kidney disease among women. Women might be prone to high alcohol consumption with kidney dysfunction.

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Blood urea nitrogen and risk of insulin use among people with diabetes

Diabetes and Vascular Disease Research ◽

10.1177/1479164118785050 ◽

2018 ◽

Vol 15 (5) ◽

pp. 409-416 ◽

Cited By ~ 6

Author(s):

Yan Xie ◽

Benjamin Bowe ◽

Tingting Li ◽

Hong Xian ◽

Ziyad Al-Aly

Keyword(s):

Glomerular Filtration Rate ◽

Confidence Interval ◽

Glomerular Filtration ◽

Blood Urea Nitrogen ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Hazard Ratio ◽

Urea Nitrogen ◽

Increased Risk ◽

Insulin Use

Laboratory evidence suggests that urea suppresses insulin secretion and sensitivity. Emerging epidemiologic evidence suggests that higher levels of urea are associated with increased risk of incident diabetes mellitus. However, whether elevated levels of blood urea nitrogen are associated with increased risk of insulin use among people with diabetes is unknown. We used the Department of Veterans Affairs databases to assemble a cohort of 197,994 incident users of non-insulin hypoglycaemic agents with an estimated glomerular filtration rate > 60 mL/min per 1.73 m2 and followed them for a median of 4.93 years. Spline analyses suggested that the relationship between blood urea nitrogen and the risk of insulin use was neutral below blood urea nitrogen level of 25 mg/dL and increased exponentially with blood urea nitrogen levels above 25 mg/dL. In survival models, compared to those with blood urea nitrogen ⩽ 25 mg/dL, those with blood urea nitrogen > 25 mg/dL had an increased risk of insulin use (hazard ratio = 1.40; confidence interval = 1.30–1.50). The risk of insulin use was increased in models which accounted for haemoglobin A1c at time zero (hazard ratio = 1.39; confidence interval = 1.28–1.50) and as a time-varying variable (hazard ratio = 1.38; confidence interval = 1.28–1.50). Two-step residual estimation analyses showed that, independent of the impact of estimated glomerular filtration rate, every 10-mg/dL increase in blood urea nitrogen concentration was associated with increased risk of insulin use (hazard ratio = 1.16; confidence interval = 1.12–1.20). Our results suggest that, among people with diabetes, higher levels of blood urea nitrogen are associated with an increased risk of insulin use.

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