{"title":"原发性醛固酮增多症患者血浆醛固酮浓度与肾小球内血液动力学之间的关系","authors":"Hideki Uedono, Masafumi Kurajoh, Norikazu Toi, Akihiro Tsuda, Kento Shinmaru, Yuya Miki, Shinya Nakatani, Yuki Nagata, Tomoaki Morioka, Katsuhito Mori, Yasuo Imanishi, Masanori Emoto","doi":"10.1093/ajh/hpae071","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In primary aldosteronism (PA), aldosterone could affect glomerular hemodynamics by elevating renal vascular resistance and glomerular capillary pressure. However, the relationship between plasma aldosterone concentrations (PAC) and glomerular hemodynamics including efferent arteriolar resistance (Re), and afferent arteriolar resistance (Ra) in humans is still unclear. The aim of this study was to investigate the relationships of PAC with intraglomerular hemodynamic parameters in patients with PA.</p><p><strong>Methods: </strong>An observational study of glomerular hemodynamics was performed using simultaneous measurements of plasma clearance of para-aminohippurate and inulin (Cin; glomerular filtration rate (GFR)) in 17 patients with PA. Kidney function was evaluated by Cin, estimated GFR based on serum creatine (eGFRcre) and serum cystatin C (eGFRcys) and creatine clearance (Ccr). Intraglomerular hemodynamic parameters, including Re, Ra, and intraglomerular hydrostatic pressure (Pglo) were calculated using Gomez's formulae.</p><p><strong>Results: </strong>In the 17 PA cases, PAC was significantly correlated with Cin (rho = 0.752, P = 0.001) and eGFRcys (rho = 0.567, P = 0.018), but was not correlated with eGFRcre and Ccr. PAC was also significantly correlated with Pglo, Re, and urinary protein/day (rho = 0.775, P = 0.0004, rho = 0.625, P = 0.009, and rho = 0.625, P = 0.007, respectively). Multivariable regression analysis showed that PAC was significantly associated with Cin and Re. In comparing aldosterone-producing adenoma (APA) and non-APA cases, Cin was significantly elevated in APA (P = 0.037), whereas eGFRcre, eGFRcys, and Ccr were not. Re tended to be higher in APA (P = 0.064).</p><p><strong>Conclusions: </strong>These results suggest high aldosterone causes glomerular hyperfiltration by constricting Re. Cin, but not eGFRcre and Ccr, may be useful for evaluating kidney function in PA.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"801-809"},"PeriodicalIF":3.2000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Plasma Aldosterone Concentration and Intraglomerular Hemodynamics in Primary Aldosteronism.\",\"authors\":\"Hideki Uedono, Masafumi Kurajoh, Norikazu Toi, Akihiro Tsuda, Kento Shinmaru, Yuya Miki, Shinya Nakatani, Yuki Nagata, Tomoaki Morioka, Katsuhito Mori, Yasuo Imanishi, Masanori Emoto\",\"doi\":\"10.1093/ajh/hpae071\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In primary aldosteronism (PA), aldosterone could affect glomerular hemodynamics by elevating renal vascular resistance and glomerular capillary pressure. However, the relationship between plasma aldosterone concentrations (PAC) and glomerular hemodynamics including efferent arteriolar resistance (Re), and afferent arteriolar resistance (Ra) in humans is still unclear. The aim of this study was to investigate the relationships of PAC with intraglomerular hemodynamic parameters in patients with PA.</p><p><strong>Methods: </strong>An observational study of glomerular hemodynamics was performed using simultaneous measurements of plasma clearance of para-aminohippurate and inulin (Cin; glomerular filtration rate (GFR)) in 17 patients with PA. Kidney function was evaluated by Cin, estimated GFR based on serum creatine (eGFRcre) and serum cystatin C (eGFRcys) and creatine clearance (Ccr). Intraglomerular hemodynamic parameters, including Re, Ra, and intraglomerular hydrostatic pressure (Pglo) were calculated using Gomez's formulae.</p><p><strong>Results: </strong>In the 17 PA cases, PAC was significantly correlated with Cin (rho = 0.752, P = 0.001) and eGFRcys (rho = 0.567, P = 0.018), but was not correlated with eGFRcre and Ccr. PAC was also significantly correlated with Pglo, Re, and urinary protein/day (rho = 0.775, P = 0.0004, rho = 0.625, P = 0.009, and rho = 0.625, P = 0.007, respectively). Multivariable regression analysis showed that PAC was significantly associated with Cin and Re. In comparing aldosterone-producing adenoma (APA) and non-APA cases, Cin was significantly elevated in APA (P = 0.037), whereas eGFRcre, eGFRcys, and Ccr were not. Re tended to be higher in APA (P = 0.064).</p><p><strong>Conclusions: </strong>These results suggest high aldosterone causes glomerular hyperfiltration by constricting Re. Cin, but not eGFRcre and Ccr, may be useful for evaluating kidney function in PA.</p>\",\"PeriodicalId\":7578,\"journal\":{\"name\":\"American Journal of Hypertension\",\"volume\":\" \",\"pages\":\"801-809\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Hypertension\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ajh/hpae071\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ajh/hpae071","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
背景/目的:在原发性醛固酮增多症(PA)中,醛固酮可通过升高肾血管阻力和肾小球毛细血管压来影响肾小球血流动力学。然而,人体血浆醛固酮浓度(PAC)与肾小球血液动力学(包括传出动脉阻力(Re)和传入动脉阻力(Ra))之间的关系仍不清楚。本研究旨在探讨 PA 患者 PAC 与肾小球内血液动力学参数之间的关系:方法:通过同时测量 17 名 PA 患者血浆中对氨基海波酸盐和菊粉的清除率(Cin;肾小球滤过率(GFR)),对肾小球血流动力学进行观察研究。肾功能通过 Cin、基于血清肌酸(eGFRcre)和血清胱抑素 C(eGFRcys)的估计 GFR 以及肌酸清除率(Ccr)进行评估。使用戈麦斯公式计算了肾小球内血液动力学参数,包括Re、Ra和肾小球内静水压(Pglo):在 17 例 PA 患者中,PAC 与 Cin(rho=0.752,p=0.001)和 eGFRcys(rho=0.567,p=0.018)显著相关,但与 GFRcre 和 Ccr 无关。PAC 还与 Pglo、Re 和尿蛋白/天明显相关(分别为 rho=0.775,p=0.0004;rho=0.625,p=0.009;rho=0.625,p=0.007)。多变量回归分析表明,PAC 与 Cin 和 Re 显著相关。在比较醛固酮生成腺瘤(APA)和非APA病例时,APA病例的Cin明显升高(p=0.037),而eGFRcre、eGFRcys和Ccr则没有升高。APA患者的Re往往更高(p=0.064):这些结果表明,高醛固酮会通过收缩 Re 导致肾小球高滤过。Cin(而非 eGFRcre 和 Ccr)可能有助于评估 PA 的肾功能。
Association Between Plasma Aldosterone Concentration and Intraglomerular Hemodynamics in Primary Aldosteronism.
Background: In primary aldosteronism (PA), aldosterone could affect glomerular hemodynamics by elevating renal vascular resistance and glomerular capillary pressure. However, the relationship between plasma aldosterone concentrations (PAC) and glomerular hemodynamics including efferent arteriolar resistance (Re), and afferent arteriolar resistance (Ra) in humans is still unclear. The aim of this study was to investigate the relationships of PAC with intraglomerular hemodynamic parameters in patients with PA.
Methods: An observational study of glomerular hemodynamics was performed using simultaneous measurements of plasma clearance of para-aminohippurate and inulin (Cin; glomerular filtration rate (GFR)) in 17 patients with PA. Kidney function was evaluated by Cin, estimated GFR based on serum creatine (eGFRcre) and serum cystatin C (eGFRcys) and creatine clearance (Ccr). Intraglomerular hemodynamic parameters, including Re, Ra, and intraglomerular hydrostatic pressure (Pglo) were calculated using Gomez's formulae.
Results: In the 17 PA cases, PAC was significantly correlated with Cin (rho = 0.752, P = 0.001) and eGFRcys (rho = 0.567, P = 0.018), but was not correlated with eGFRcre and Ccr. PAC was also significantly correlated with Pglo, Re, and urinary protein/day (rho = 0.775, P = 0.0004, rho = 0.625, P = 0.009, and rho = 0.625, P = 0.007, respectively). Multivariable regression analysis showed that PAC was significantly associated with Cin and Re. In comparing aldosterone-producing adenoma (APA) and non-APA cases, Cin was significantly elevated in APA (P = 0.037), whereas eGFRcre, eGFRcys, and Ccr were not. Re tended to be higher in APA (P = 0.064).
Conclusions: These results suggest high aldosterone causes glomerular hyperfiltration by constricting Re. Cin, but not eGFRcre and Ccr, may be useful for evaluating kidney function in PA.
期刊介绍:
The American Journal of Hypertension is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of hypertension and related cardiovascular disease. The journal publishes high-quality original research and review articles on basic sciences, molecular biology, clinical and experimental hypertension, cardiology, epidemiology, pediatric hypertension, endocrinology, neurophysiology, and nephrology.