MP37-05 PREOPERATIVE PLASMA ALDOSTERONE-TO-RENIN RATIO IS A PREDICTOR OF DECREMENT IN GLOMERULAR FILTRATION RATE AFTER ADRENALECTOMY FOR PRIMARY ALDOSTERONISM

You have accessJournal of UrologyAdrenal1 Apr 2017MP37-05 PREOPERATIVE PLASMA ALDOSTERONE-TO-RENIN RATIO IS A PREDICTOR OF DECREMENT IN GLOMERULAR FILTRATION RATE AFTER ADRENALECTOMY FOR PRIMARY ALDOSTERONISM Keiko Fujino, Toshiaki Tanaka, Toshihiro Maeda, and Naoya Masumori Keiko FujinoKeiko Fujino More articles by this author , Toshiaki TanakaToshiaki Tanaka More articles by this author , Toshihiro MaedaToshihiro Maeda More articles by this author , and Naoya MasumoriNaoya Masumori More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients with primary aldosteronism (PA), excessive aldosterone causes glomerular hyperfiltration, which can be associated with increase in glomerular filtration ratio (GFR). After treatment of PA, correction of hyperfiltration may decrease GFR. Therefore, decrement in GFR can be a clinically significant problem after treatment of PA. The aim of this study was to determine the prevalence of renal deterioration and new onset chronic kidney disease (CKD), and identify the predictors of decreasing estimated GFR (eGFR) after laparoscopic adrenalectomy for aldosterone-producing adenoma. METHODS In our institution, 64 patients underwent laparoscopic adrenalectomy for PA between 2001 and 2015. Of them, 41 patients who received postoperative surveillance for more than 12 months were included in this retrospective study. Preoperative parameters including age, sex, duration of hypertension, eGFR, the ratio of plasma aldosterone (pg/mL) to plasma renin activity (ng/mL/hr) ratio (ARR), tumor size and operation time were evaluated to determine risk factors for postoperative deterioration of eGFR (>25% decrement from preoperative level) and new onset CKD (eGFR <60 ml/min/1.73m2). RESULTS Median followup was 58 months (range 12-187). Mean preoperative eGFR was significantly decreased from 73.6 ± 19.7 ml/min/1.73m2 at baseline to 61.0 ± 18.9 ml/min/1.73m2 at the latest followup (p<0.01). Fifteen patients (36.6%) showed postoperative deterioration of eGFR. ARR was the only significant predictive factor for postoperative deterioration of eGFR. Using a cutoff point of 2000, sensitivity and specificity were 62.5% and 77.2%, respectively. Excluding 11 patients who had CKD before operation, 13 (43.3%) of 30 patients developed new onset CKD after operation. We could not determine a significant predictor for postoperative new onset CKD. CONCLUSIONS Postoperative renal deterioration is prevalent in patients with PA. High ARR may be associated with the degree of glomerular hyperfiltration and irreversible renal damage and is a predictive factor of eGFR decrement after removal of adenoma. Postoperative surveillance of renal function and management of CKD are essential in patients who underwent adrenalectomy for PA. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e476 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Keiko Fujino More articles by this author Toshiaki Tanaka More articles by this author Toshihiro Maeda More articles by this author Naoya Masumori More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...