原发性醛固酮增多症合并肾动脉狭窄的临床特点和诊断

Clinical Characteristics of Coexisting Primary Aldosteronism and Renal Artery Stenosis

目的分析肾动脉狭窄合并原发性醛固酮增多症患者的临床特点及预后。方法回顾性分析10例确诊为肾动脉狭窄合并原发性醛固酮增多症的患者的临床基线资料、实验室检查结果、影像学检查特点、治疗情况以及随访资料。结果所有患者均因3级高血压入院,70%的患者合并有低钾血症。50%的患者入院时原发性醛固酮增多症的筛查试验结果为阴性。4例患者同时进行了肾动脉支架植入术和经腹腔镜肾上腺切除术或肾上腺消融术。4例患者仅行肾动脉支架置入术。2例患者未接受任何手术或介入治疗。后续随访表明,同时针对两种疾病进行药物或手术治疗后,患者高血压情况均得到有效控制。结论在合并肾动脉狭窄的患者中行原发性醛固酮增多症的筛查试验,应谨慎解读结果。建议对于在解除肾动脉狭窄后依然存在难治性高血压的患者复查筛查实验,以明确有无合并原发性醛固酮增多症。

Objective To summarize clinical features of patients with primary aldosteronism(PA)concurrent with renal artery stenosis(RAS).Methods The baseline characteristics,imaging features,laboratory results and follow-up data of 10 patients diagnosed with PA and RAS were retrospectively analyzed.Results All patients were admitted for grade 3 hypertension and 70%of them were with hypokalemia.50%patients had normal aldosterone-to-renin ratio(ARR)at the time of admission.4 patients received both renal artery stenting for RAS and adrenalectomy for PA.4 patients received renal artery stenting only.2 patients did not have any intervention or surgical treatment due to aging or individual willingness.After treatment,all patients had their blood pressure under better control.Conclusion Screening tests for PA has a high false negative rate among patients co-existed with RAS thus should be carefully interpreted.It is recommended that PA screening tests should be reperformed among patients who still have refractory hypertension after intervention of RAS.