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Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy

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 aldoster...

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Autores principales: Nakano, Yujiro, Yoshimoto, Takanobu, Fukuda, Tatsuya, Murakami, Masanori, Bouchi, Ryotaro, Minami, Isao, Hashimoto, Koshi, Fujii, Yasuhisa, Kihara, Kazunori, Ogawa, Yoshihiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society of Internal Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172537/
https://www.ncbi.nlm.nih.gov/pubmed/29709927
http://dx.doi.org/10.2169/internalmedicine.0438-17
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author Nakano, Yujiro
Yoshimoto, Takanobu
Fukuda, Tatsuya
Murakami, Masanori
Bouchi, Ryotaro
Minami, Isao
Hashimoto, Koshi
Fujii, Yasuhisa
Kihara, Kazunori
Ogawa, Yoshihiro
author_facet Nakano, Yujiro
Yoshimoto, Takanobu
Fukuda, Tatsuya
Murakami, Masanori
Bouchi, Ryotaro
Minami, Isao
Hashimoto, Koshi
Fujii, Yasuhisa
Kihara, Kazunori
Ogawa, Yoshihiro
author_sort Nakano, Yujiro
collection PubMed
description 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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spelling pubmed-61725372018-10-09 Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy Nakano, Yujiro Yoshimoto, Takanobu Fukuda, Tatsuya Murakami, Masanori Bouchi, Ryotaro Minami, Isao Hashimoto, Koshi Fujii, Yasuhisa Kihara, Kazunori Ogawa, Yoshihiro Intern Med Original Article 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. The Japanese Society of Internal Medicine 2018-04-27 2018-09-01 /pmc/articles/PMC6172537/ /pubmed/29709927 http://dx.doi.org/10.2169/internalmedicine.0438-17 Text en Copyright © 2018 by The Japanese Society of Internal Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Nakano, Yujiro
Yoshimoto, Takanobu
Fukuda, Tatsuya
Murakami, Masanori
Bouchi, Ryotaro
Minami, Isao
Hashimoto, Koshi
Fujii, Yasuhisa
Kihara, Kazunori
Ogawa, Yoshihiro
Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title_full Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title_fullStr Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title_full_unstemmed Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title_short Effect of Eplerenone on the Glomerular Filtration Rate (GFR) in Primary Aldosteronism: Sequential Changes in the GFR During Preoperative Eplerenone Treatment to Subsequent Adrenalectomy
title_sort effect of eplerenone on the glomerular filtration rate (gfr) in primary aldosteronism: sequential changes in the gfr during preoperative eplerenone treatment to subsequent adrenalectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172537/
https://www.ncbi.nlm.nih.gov/pubmed/29709927
http://dx.doi.org/10.2169/internalmedicine.0438-17
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