Markers of Kidney Tubular Function Deteriorate While Those of Kidney Tubule Health Improve in Primary Aldosteronism After Targeted Treatments

Background Targeted treatment with mineralocorticoid receptor antagonists (MRAs) or adrenalectomy in patients with primary aldosteronism (PA) causes a decline in estimated glomerular filtration rate; however, the associated simultaneous changes in biomarkers of kidney tubule health still remain uncl...

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Published in:Journal of the American Heart Association 2023-02, Vol.12 (4), p.e028146-e028146
Main Authors: Wu, Vin-Cent, Chan, Chieh-Kai, Chueh, Jeff S, Chen, Yung-Ming, Lin, Yen-Hung, Chang, Chin-Chen, Lin, Po-Chih, Chung, Shiu-Dong
Format: Article
Language:English
Subjects:
Biomarkers
Creatinine
cystatin C
Cystatin C - metabolism
Essential Hypertension - diagnosis
Essential Hypertension - drug therapy
Glomerular Filtration Rate - physiology
Humans
Hyperaldosteronism - diagnosis
Hyperaldosteronism - drug therapy
Hyperaldosteronism - surgery
iPTH
Kidney - metabolism
kidney failure
Kidney Tubules
KIM‐1
L‐FABP
Minerals
Original Research
proteinuria
Proteinuria - diagnosis
Renal Insufficiency - metabolism
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Summary:Background Targeted treatment with mineralocorticoid receptor antagonists (MRAs) or adrenalectomy in patients with primary aldosteronism (PA) causes a decline in estimated glomerular filtration rate; however, the associated simultaneous changes in biomarkers of kidney tubule health still remain unclear. Methods and Results We matched 104 patients with newly diagnosed unilateral PA who underwent adrenalectomy with 104 patients with unilateral PA who were treated with MRAs, 104 patients with bilateral PA treated with MRAs, and 104 patients with essential hypertension who served as controls. Functional biomarkers were measured before the targeted treatment and 1 year after treatment, including serum markers of kidney function (cystatin C, creatinine), urinary markers of proximal renal tubular damage (L-FABP [liver-type fatty-acid binding protein], KIM-1 [kidney injury molecule-1]), serum markers of kidney tubular reserve and mineral metabolism (intact parathyroid hormone), and proteinuria. Compared with the patients with essential hypertension, the patients with PA had higher pretreatment serum intact parathyroid hormone and urinary creatinine-corrected parameters, including L-FABP, KIM-1, and albumin. The patients with essential hypertension and with PA had similar cystatin C levels. After treatment with MRAs or adrenalectomy of unilateral PA and MRAs of bilateral PA, the patients with PA had increased serum cystatin C and decreased urinary L-FABP/creatinine, KIM-1/creatinine, creatinine-based estimated glomerular filtration rate, intact parathyroid hormone, and proteinuria (all
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.122.028146