Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

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Published ahead of print on April 25, 2007

Clin J Am Soc Nephrol 2: 722-731, 2007

C 2007 American Society of Nephrology

doi: 10.2215/CJN.00050107

Hypertension

Relationships of Plasma Renin Levels with Renal Function in Patients with

Primary Aldosteronism

Cristiana Catena, GianLuca Colussi, Nadalini, Alessandra Chiuch, Sara

Baroselli, a Lapenna, and Leonardo A. Sechi

Hypertension Unit, Division of Internal Medicine, Department of Experimental

and Clinical Pathology and Medicine, University of Udine, Udine, Italy

Address correspondence to: Dr. Leonardo A. Sechi, Clinica Medica, University

of Udine, Piazzale S. della Misericordia, 1, 33100 Udine, Italy.

Phone: +39-0432-559804; Fax: +39-0432-42097; E-mail: sechi@...

Background: The renal damage that is present in primary aldosteronism might

reflect functional and potentially reversible abnormalities that are

initiated by glomerular hyperfiltration. The aim of this study was to

investigate the relationships of plasma renin and aldosterone concentrations

with renal outcomes after treatment of primary aldosteronism.

Design, setting, participants, and measurements: Fifty-six consecutive

patients who had primary aldosteronism and were recruited in a university

center were studied. Patients were prospectively followed after either

surgical or medical treatment for a mean of 6.2 yr, during which they

received antihypertensive drugs to reach a target BP of <140/90 mmHg.

Results: At baseline, patients with primary aldosteronism had higher

creatinine clearance and albuminuria than 323 patients with essential

hypertension and 113 normotensive individuals. In patients with primary

aldosteronism, plasma active renin levels that were higher than the lower

limit of detection (2.5 pg/ml) were associated with higher BP, plasma

potassium, and albuminuria and lower creatinine clearance. Plasma

aldosterone concentrations that were higher than the median value (225

pg/ml) were associated with lower plasma potassium and higher creatinine

clearance. Creatinine clearance was correlated directly with plasma

aldosterone and inversely with renin. During follow-up, patients with higher

baseline plasma renin required use of more antihypertensive drugs to obtain

BP control and had a smaller early decline in albuminuria than did patients

with suppressed renin.

Conclusions: Escape of renin from suppression by excess aldosterone is

associated with evidence of more severe renal damage in patients with

primary aldosteronism and predicts less favorable outcomes after treatment.