Cargando…
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...
Autores principales: | , , , , , , , , , |
---|---|
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 |
_version_ | 1783360968348139520 |
---|---|
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. |
format | Online Article Text |
id | pubmed-6172537 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | The Japanese Society of Internal Medicine |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT nakanoyujiro effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT yoshimototakanobu effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT fukudatatsuya effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT murakamimasanori effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT bouchiryotaro effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT minamiisao effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT hashimotokoshi effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT fujiiyasuhisa effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT kiharakazunori effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy AT ogawayoshihiro effectofeplerenoneontheglomerularfiltrationrategfrinprimaryaldosteronismsequentialchangesinthegfrduringpreoperativeeplerenonetreatmenttosubsequentadrenalectomy |