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Adv Chronic Kidney Dis. 2015 May;22(3):196-203. doi: 10.1053/j.ackd.2014.10.003.

Outcomes of drug-based and surgical treatments for primary aldosteronism.

Author information

1
Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Faculty of Medicine, Sorbonne Universités, UPMC Univ Paris 06, Paris, France; LIMICS, INSERM, UMR_S1142, Paris, France; Clinical Investigation Centre 9201, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Clinical Investigation Centre 9201, INSERM, Paris, France; Faculty of Medicine, Université Paris-Descartes, Paris, France; Department of Visceral Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and the Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: olivier.steichen@tnn.aphp.fr.
2
Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Faculty of Medicine, Sorbonne Universités, UPMC Univ Paris 06, Paris, France; LIMICS, INSERM, UMR_S1142, Paris, France; Clinical Investigation Centre 9201, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Clinical Investigation Centre 9201, INSERM, Paris, France; Faculty of Medicine, Université Paris-Descartes, Paris, France; Department of Visceral Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and the Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.

Abstract

Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia, and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure (BP) and medications in most cases and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control BP. Dietary sodium restriction should be implemented in all cases because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of BP, serum potassium concentration, or cardiovascular and kidney outcomes, although the benefits of treatment tend to be observed sooner with surgery. Patients with PA display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing CKD in 30% of patients. However, further kidney damage is lessened by the treatment of PA.

KEYWORDS:

Adrenalectomy; Chronic kidney disease; Epithelial sodium channel blockers; Hyperaldosteronism; Mineralocorticoid receptor antagonists

PMID:
25908468
DOI:
10.1053/j.ackd.2014.10.003
[Indexed for MEDLINE]
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