TY - JOUR
T1 - Effect of eplerenone on the glomerular filtration rate (GFR) in primary aldosteronism
T2 - Sequential changes in the GFR during preoperative eplerenone treatment to subsequent adrenalectomy
AU - Nakano, Yujiro
AU - Yoshimoto, Takanobu
AU - Fukuda, Tatsuya
AU - Murakami, Masanori
AU - Bouchi, Ryotaro
AU - Minami, Isao
AU - Hashimoto, Koshi
AU - Fujii, Yasuhisa
AU - Kihara, Kazunori
AU - Ogawa, Yoshihiro
N1 - Funding Information:
This research was supported by AMED under Grant Number * JP17ek0109122*, conducted as a part of the Japan Primary Aldosteronism Study (JPAS), and partly supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan (T.Y., 16K08962 and M.M, 16K 19392).
Publisher Copyright:
© 2018 The Japanese Society of Internal Medicine.
PY - 2018
Y1 - 2018
N2 - Objective Eplerenone (EPL) is a mineralo-corticoid receptor antagonist that is highly selective and has few side effects. This study was conducted to examine whether or not EPL treatment was able to reverse glomerular hyperfiltration, as an indicator of aldosterone renal action, in primary aldosteronism (PA) patients. Methods Changes in the estimated glomerular filtration rate (ΔGFR) were examined in 102 PA patients with EPL treatment. Furthermore, the sequential ΔGFR in 40 patients initially treated with EPL followed by adrenalectomy was examined in order to evaluate the extent of the remaining glomerular hyperfiltration in the patients treated with EPL. Results EPL decreased the GFR at 1 month after treatment. The GFR at baseline was the sole significant predictor for the ΔGFR. Patients initially treated by EPL followed by adrenalectomy showed three different ΔGFR patterns during the treatment, despite having comparable doses of EPL and comparable control of blood pressure and serum potassium levels. The urinary aldosterone excretion was significantly different among these three groups, and the group with no decrease in the GFR after EPL treatment showed greater urinary aldosterone excretion. Glomerular hyperfiltration was completely restored only in 17.5% of our unilateral PA patients after EPL treatment. Conclusion The present study revealed that blockade of aldosterone action by EPL could, at least partially, reverse glomerular hyperfiltration in PA. Whether or not these differential effects on the GFR affect the long-term outcome needs to be investigated, especially in patients with unilateral PA who do not want adrenalectomy and choose the EPL treatment option.
AB - Objective Eplerenone (EPL) is a mineralo-corticoid receptor antagonist that is highly selective and has few side effects. This study was conducted to examine whether or not EPL treatment was able to reverse glomerular hyperfiltration, as an indicator of aldosterone renal action, in primary aldosteronism (PA) patients. Methods Changes in the estimated glomerular filtration rate (ΔGFR) were examined in 102 PA patients with EPL treatment. Furthermore, the sequential ΔGFR in 40 patients initially treated with EPL followed by adrenalectomy was examined in order to evaluate the extent of the remaining glomerular hyperfiltration in the patients treated with EPL. Results EPL decreased the GFR at 1 month after treatment. The GFR at baseline was the sole significant predictor for the ΔGFR. Patients initially treated by EPL followed by adrenalectomy showed three different ΔGFR patterns during the treatment, despite having comparable doses of EPL and comparable control of blood pressure and serum potassium levels. The urinary aldosterone excretion was significantly different among these three groups, and the group with no decrease in the GFR after EPL treatment showed greater urinary aldosterone excretion. Glomerular hyperfiltration was completely restored only in 17.5% of our unilateral PA patients after EPL treatment. Conclusion The present study revealed that blockade of aldosterone action by EPL could, at least partially, reverse glomerular hyperfiltration in PA. Whether or not these differential effects on the GFR affect the long-term outcome needs to be investigated, especially in patients with unilateral PA who do not want adrenalectomy and choose the EPL treatment option.
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U2 - 10.2169/internalmedicine.0438-17
DO - 10.2169/internalmedicine.0438-17
M3 - Article
C2 - 29709927
AN - SCOPUS:85052851840
VL - 57
SP - 2459
EP - 2466
JO - Internal Medicine
JF - Internal Medicine
SN - 0918-2918
IS - 17
ER -