Published online before print June 26, 2006, doi: 10.1161/01.HYP.0000230444.01215.6a
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2006;48:232.)
© 2006 American Heart Association, Inc.
Original Articles |
Renal Damage in Primary Aldosteronism
Results of the PAPY Study
From the Department of Clinical and Experimental Medicine, Clinica Medica 4, University Hospital, Padova, Italy.
Correspondence to Gian Paolo Rossi, DMCS Clinica Medica 4, University Hospital, via Giustiniani, 2, 35126 Padova, Italy. E-mail gianpaolo.rossi{at}unipd.it
Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH). Patients (n=1180) underwent a predefined screening protocol followed by tests for confirming PA and identifying the underlying adrenocortical pathology. Renal damage was assessed by 24-hour urine albumin excretion (UAE) rate and glomerular filtration rate (GFR). UAE rate was measured in 490 patients; all had a normal GFR. Of them, 31 (6.4%) had APA, 33 (6.7%) had IHA, and the rest (86.9%) had PH. UAE rate was predicted (P<0.001) by body mass index, age, urinary Na+ excretion, serum K+, and mean blood pressure. Covariate-adjusted UAE rate was significantly higher in APA and IHA than in PH patients; there were more patients with microalbuminuria in the APA and IHA than in the PH group (P=0.007). Among the hypertensive patients with a preserved GFR, those with APA or IHA have a higher UAE rate than comparable PH patients. Thus, hypertension because of excess autonomous aldosterone secretion features an early and more prominent renal damage than PH.
Key Words: hypertension, endocrine • aldosterone • mineralocorticoids • kidney • hypertrophy • adrenal gland
Related Article:
Hypertension 2006 48: 209-210.
This article has been cited by other articles:
 |
|
 |
|
  M. Stowasser Update in Primary Aldosteronism J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3623 - 3630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Sechi, A. Di Fabio, M. Bazzocchi, A. Uzzau, and C. Catena Intrarenal Hemodynamics in Primary Aldosteronism before and after Treatment J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1191 - 1197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Born-Frontsberg, M. Reincke, L. C. Rump, S. Hahner, S. Diederich, R. Lorenz, B. Allolio, J. Seufert, C. Schirpenbach, F. Beuschlein, et al. Cardiovascular and Cerebrovascular Comorbidities of Hypokalemic and Normokalemic Primary Aldosteronism: Results of the German Conn's Registry J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1125 - 1130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ritz How Little Aldosterone is Able to Raise Blood Pressure? Clin. J. Am. Soc. Nephrol., April 1, 2009; 4(4): 703 - 710. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Matrozova, O. Steichen, L. Amar, S. Zacharieva, X. Jeunemaitre, and P.-F. Plouin Fasting Plasma Glucose and Serum Lipids in Patients With Primary Aldosteronism: A Controlled Cross-Sectional Study Hypertension, April 1, 2009; 53(4): 605 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Reincke, L. C. Rump, M. Quinkler, S. Hahner, S. Diederich, R. Lorenz, J. Seufert, C. Schirpenbach, F. Beuschlein, M. Bidlingmaier, et al. Risk Factors Associated with a Low Glomerular Filtration Rate in Primary Aldosteronism J. Clin. Endocrinol. Metab., March 1, 2009; 94(3): 869 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T.-Y. Chun, P. N. Chander, J.-W. Kim, J. H. Pratt, and C. T. Stier Jr. Aldosterone, but not angiotensin II, increases profibrotic factors in kidney of adrenalectomized stroke-prone spontaneously hypertensive rats Am J Physiol Endocrinol Metab, August 1, 2008; 295(2): E305 - E312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Rayner Primary aldosteronism and aldosterone-associated hypertension J. Clin. Pathol., July 1, 2008; 61(7): 825 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Romero, M. W. Plonczynski, C. A. Carvajal, E. P. Gomez-Sanchez, and C. E. Gomez-Sanchez Microribonucleic Acid-21 Increases Aldosterone Secretion and Proliferation in H295R Human Adrenocortical Cells Endocrinology, May 1, 2008; 149(5): 2477 - 2483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Krug and M. Ehrhart-Bornstein Aldosterone and Metabolic Syndrome: Is Increased Aldosterone in Metabolic Syndrome Patients an Additional Risk Factor? Hypertension, May 1, 2008; 51(5): 1252 - 1258. [Full Text] [PDF]
|
|
|
|
|
|
E. Pimenta, K. K. Gaddam, M. N. Pratt-Ubunama, M. K. Nishizaka, I. Aban, S. Oparil, and D. A. Calhoun Relation of Dietary Salt and Aldosterone to Urinary Protein Excretion in Subjects With Resistant Hypertension Hypertension, February 1, 2008; 51(2): 339 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Romero, M. W. Plonczynski, B. L. Welsh, C. E. Gomez-Sanchez, M. Y. Zhou, and E. P. Gomez-Sanchez Gene expression profile in rat adrenal zona glomerulosa cells stimulated with aldosterone secretagogues Physiol Genomics, December 19, 2007; 32(1): 117 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Lenzini, T. M. Seccia, E. Aldighieri, A. S. Belloni, P. Bernante, L. Giuliani, G. G. Nussdorfer, A. C. Pessina, and G. P. Rossi Heterogeneity of Aldosterone-Producing Adenomas Revealed by a Whole Transcriptome Analysis Hypertension, December 1, 2007; 50(6): 1106 - 1113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Auchus and M. H. Drazner Will the Lessons From Primary Aldosteronism Change the Treatment of Hypertension and Left Ventricular Hypertrophy? Hypertension, November 1, 2007; 50(5): 837 - 839. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ye, B. Mariniello, F. Mantero, H. Shibata, and W. E Rainey G-protein-coupled receptors in aldosterone-producing adenomas: a potential cause of hyperaldosteronism J. Endocrinol., October 1, 2007; 195(1): 39 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G Romero, M. Y. Zhou, L. L Yanes, M. W Plonczynski, T. R Washington, C. E Gomez-Sanchez, and E. P Gomez-Sanchez Regulators of G-protein signaling 4 in adrenal gland: localization, regulation, and role in aldosterone secretion J. Endocrinol., August 1, 2007; 194(2): 429 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Farah, K. M. Elased, and M. Morris Genetic and dietary interactions: role of angiotensin AT1a receptors in response to a high-fructose diet Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H1083 - H1089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Auchus, D. W. Chandler, S. Singeetham, N. Chokshi, F. E. Nwariaku, B. L. Dolmatch, S. A. Holt, F. H. Wians Jr., S. C. Josephs, C. K. Trimmer, et al. Measurement of 18-Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2648 - 2651. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Catena, G. Colussi, E. Nadalini, A. Chiuch, S. Baroselli, R. Lapenna, and L. A. Sechi Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 722 - 731. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Otani, F. Otsuka, K. Inagaki, M. Takeda, T. Miyoshi, J. Suzuki, T. Mukai, T. Ogura, and H. Makino Antagonistic effects of bone morphogenetic protein-4 and -7 on renal mesangial cell proliferation induced by aldosterone through MAPK activation Am J Physiol Renal Physiol, May 1, 2007; 292(5): F1513 - F1525. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. N. Pratt-Ubunama, M. K. Nishizaka, R. L. Boedefeld, S. S. Cofield, S. M. Harding, and D. A. Calhoun Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension Chest, February 1, 2007; 131(2): 453 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. E. Mann What's new in hypertension? Nephrol. Dial. Transplant., January 1, 2007; 22(1): 47 - 52. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Calhoun Aldosterone and Cardiovascular Disease: Smoke and Fire Circulation, December 12, 2006; 114(24): 2572 - 2574. [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, et al. A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2293 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Nagase, S. Yoshida, S. Shibata, T. Nagase, T. Gotoda, K. Ando, and T. Fujita Enhanced Aldosterone Signaling in the Early Nephropathy of Rats with Metabolic Syndrome: Possible Contribution of Fat-Derived Factors J. Am. Soc. Nephrol., December 1, 2006; 17(12): 3438 - 3446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Catena, G. Colussi, and L. A. Sechi Renal Function in Primary Aldosteronism Hypertension, December 1, 2006; 48(6): e110 - e110. [Full Text] [PDF]
|
|
|
|
|
|
G. P. Rossi, F. Mantero, A. C. Pessina, and For the PAPY Study Investigators Response to Renal Function in Primary Aldosteronism: Is Glomerular Hyperfiltration a Hallmark of Primary Aldosteronism? Further Results from the Primary Aldosteronism Prevalence in Hypertension (PAPY) Study Hypertension, December 1, 2006; 48(6): e111 - e112. [Full Text] [PDF]
|
|
|
|
|
|
E. Pimenta and D. A. Calhoun Aldosterone, Dietary Salt, and Renal Disease Hypertension, August 1, 2006; 48(2): 209 - 210. [Full Text] [PDF]
|
|