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- Kota Nishihama, Chisa Inoue, Kohei Nishikawa, Yuko Okano, Atsuro Takeshita, Mei Uemura, Taro Yasuma, Toshinari Suzuki, Ryuji Okamoto, Corina N D'Alessandro-Gabazza, Esteban C Gabazza, and Yutaka Yano.
- Department of Diabetes, Metabolism and Endocrinology, Mie University Graduate School of Medicine, Japan.
- Intern. Med. 2024 Jun 1; 63 (11): 159716021597-1602.
AbstractA 42-year-old Japanese woman with end-stage renal failure due to hypertension presented with a systolic blood pressure of 160-200 mmHg despite treatment with 4 different antihypertensive agents. The plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were elevated. Adrenal vein sampling suggested bilateral excessive aldosterone secretion, whereas adrenocortical scintigraphy showed right-dominant accumulation. Open bilateral nephrectomy and right adrenalectomy improved the systolic blood pressure, PAC, and PRA. A pathological examination revealed zona glomerulosa hyperplasia but not microaldosteronoma. This report shows that bilateral nephrectomy, not unilateral adrenalectomy, is a potentially effective treatment option for resistant hypertension with an elevated renin-angiotensin-aldosterone system in hemodialysis patients.
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