单侧原发性醛固酮增多症患者肾上腺切除术后高尿酸血症和肾功能损害的比较研究:组织病理学亚型是否重要?

IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY BMC Nephrology Pub Date : 2024-10-13 DOI:10.1186/s12882-024-03750-4
Chu-Wen Fang, Hui-Lung Hsieh, Shuo-Meng Wang, Kuo-How Huang, Kang-Yung Peng, Yen-Hung Lin, Vin-Cent Wu, Jeff S Chueh
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引用次数: 0

摘要

背景:原发性醛固酮增多症(PA)存在于 5-18% 的高血压患者中,是继发性高血压的主要病因。单侧原发性醛固酮增多症(uPA)患者通常建议进行肾上腺切除术,长期疗效良好。肾上腺切除术前无高尿酸血症和慢性肾功能衰竭的原发性醛固酮增多症患者被纳入了这项队列研究。肾上腺切除术后一年测量了血清尿酸(SUA)和肾滤过率。研究还探讨了它们与病理特征、组织病理学亚型(经典或非经典(HISTALDO共识))和血管僵硬度之间的关系。这项队列研究旨在评估肾上腺切除术后血清尿酸(SUA)水平和估计肾小球滤过率(eGFR)与 HISTALDO 共识所描述的病理特征之间的相关性。此外,该研究还试图评估这些生化指标对随访一年的外周血管僵化和肱踝脉搏波速度(baPWV)的影响:这项前瞻性队列研究纳入了2007年1月1日至2022年12月31日期间接受肾上腺切除术的uPA患者(N = 100):随访时,经典组比非经典组更常见SUA升高、高尿酸血症和eGFR下降> 25%。术后高尿酸血症(此处称为肾切除术后高尿酸血症(PAHU))的发生率为29%(29/100),经典组为34.8%(23/66),非经典组为17.6%(6/34)。eGFR下降>25%的发生率分别为33%(33/100)、43.9%(29/66)和11.8%(4/34):对于伴有PAHU和/或肾功能损害的PA患者,我们建议监测SUA、pH值、尿尿酸和尿结晶,并进行KUB检查和外周血管及肾脏超声检查(KUB中的纯尿酸结石呈放射状),以确定无症状PAHU病例是否需要药物干预,尤其是男性、典型组织病理学或肾功能损害患者。
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A comparative study of postadrenalectomy hyperuricemia and renal impairment in patients with unilateral primary aldosteronism: does histopathology subtype matter?

Background: Primary aldosteronism (PA), which is present in 5-18% of hypertensive patients, is a leading cause of secondary hypertension. Adrenalectomy is often recommended for patients with unilateral primary aldosteronism (uPA), yielding good long-term outcomes. PA patients without hyperuricemia and chronic renal failure before adrenalectomy were enrolled in this cohort study. Serum uric acid (SUA) and renal filtration were measured one year post-adrenalectomy. Their relationships with pathologic features, histopathological subtype (classical or nonclassical (HISTALDO consensus)), and vessel stiffness were explored. The aim of this cohort study is to evaluate the correlation between post-adrenalectomy serum uric acid (SUA) levels and estimated glomerular filtration rate (eGFR) with the pathologic features delineated by the HISTALDO consensus. Additionally, the study seeks to assess the impact of these biochemical markers on peripheral vessel stiffness and brachial-ankle pulse wave velocity (baPWV) at a one-year follow-up visit.

Methods: This prospective cohort study included patients (N = 100) diagnosed with uPA who underwent adrenalectomy from Jan 1, 2007 to Dec 31, 2022.

Results: At follow-up, elevated SUA, hyperuricemia, and a > 25% eGFR decrease were significantly more common in the classical than the nonclassical group. The incidence of postoperative hyperuricemia, herein referred to as post-adrenalectomy hyperuricemia (PAHU), was 29% (29/100) overall, 34.8% (23/66) in the classical group and 17.6% (6/34) in the nonclassical group. The incidence of eGFR reduction > 25% was 33% (33/100), 43.9% (29/66), and 11.8% (4/34), respectively. baPWV decreased more in the classical group than the nonclassical group.

Conclusion: For PA patients with PAHU and/or renal impairment, we suggest monitoring SUA, pH, urine uric acid, and urine crystals and performing a KUB study and peripheral vascular and renal sonography (on which pure uric acid stones in the KUB are radiolucent) to determine whether drug intervention is required for cases of asymptomatic PAHU, especially patients in male gender, classical histopathology, or renal impairment.

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来源期刊
BMC Nephrology
BMC Nephrology UROLOGY & NEPHROLOGY-
CiteScore
4.30
自引率
0.00%
发文量
375
审稿时长
3-8 weeks
期刊介绍: BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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