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Hypokalemia aldosterone

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https://www.readbyqxmd.com/read/28735756/incidence-and-determinants-of-hyperkalemia-and-hypokalemia-in-a-large-healthcare-system
#1
Erik Nilsson, Alessandro Gasparini, Johan Ärnlöv, Hairong Xu, Karin M Henriksson, Josef Coresh, Morgan E Grams, Juan Jesus Carrero
BACKGROUND: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system. METHODS: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Over 3-years, we estimated the incidence of hypokalemia, defined as potassium<3...
July 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28722461/-disorders-of-water-and-electrolyte-metabolism-and-changes-in-acid-base-balance-in-patients-with-ascitic-liver-cirrhosis
#2
Halima Gottfriedová, Miroslava Horáčková, Milena Čáslavská, Julius Špičák, Otto Schück
In patients with advanced cirrhosis with ascites disorders of water and electrolyte metabolism are often present and they are associated with changes in acid-base balance. These changes can be very complicated, their diagnosis and treatment difficult. Dilutional hyponatremia is the most common disorder. Hyponatremia in these patients is associated with increased morbidity and mortality before and after liver transplantation. Other common disorders include hyperchloremic acidosis, hypokalemia, metabolic alkalosis, lactic acidosis, respiratory alkalosis...
2017: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/28708774/identifying-unilateral-disease-in-chinese-patients-with-primary-aldosteronism-by-using-a-modified-prediction-score
#3
Ying Zhang, Wenquan Niu, Fangfang Zheng, Hua Zhang, Wenlong Zhou, Zhoujun Shen, Jianzhong Xu, Xiaofeng Tang, Jin Zhang, Ping-Jin Gao, Ji-Guang Wang, Limin Zhu
OBJECTIVE: The current study aimed to evaluate the role of Küpers' score in predicting unilateral aldosteronism, and develop a modified score in Chinese patients with primary aldosteronism. METHODS: The current retrospective study included 406 patients with primary aldosteronism who underwent successful adrenal venous sampling (AVS) and were divided into the unilateral (n = 211) and bilateral (n = 195) groups according to the AVS results. Normokalemia was noted in both the unilateral (n = 64) and bilateral groups (n = 84) when plasma and urinary aldosterone were measured...
July 20, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28700713/increased-urinary-prostaglandin-e2-metabolite-a-potential-therapeutic-target-of-gitelman-syndrome
#4
Xiaoyan Peng, Lanping Jiang, Chen Chen, Yan Qin, Tao Yuan, Ou Wang, Xiaoping Xing, Xuemei Li, Min Nie, Limeng Chen
BACKGROUND: Gitelman syndrome (GS), an inherited autosomal recessive salt-losing renal tubulopathy caused by mutations in SLC12A3 gene, has been associated with normal prostaglandin E2 (PGE2) levels since 1995 by a study involving 11 clinically diagnosed patients. However, it is difficult to explain why cyclooxygenase-2 (COX2) inhibitors, which pharmacologically reduce PGE2 synthesis, are helpful to patients with GS, and few studies performed in the last 20 years have measured PGE2 levels...
2017: PloS One
https://www.readbyqxmd.com/read/28699986/diagnosis-and-management-of-primary-aldosteronism
#5
Leticia A P Vilela, Madson Q Almeida
Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia...
May 2017: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28697837/-poor-weight-gain-recurrent-metabolic-alkalosis-and-hypokalemia-in-a-neonate
#6
Miao Qian, Shu-Ping Han, Zhang-Bing Yu, Xiao-Hui Chen
The study reports a female neonate with a gestational age of 29(+2) weeks and a birth weight of 1 210 g. Ten minutes after birth, the neonate was admitted to the hospital due to shortness of breath. Several days after birth, the neonate presented with hyperglycemia, polyuria, and poor weight gain, accompanied by azotemia, hypochloremic metabolic alkalosis, hypokalemia, and hyponatremia. Laboratory examinations showed elevated levels of aldosterone, renin, and angiotensin II. Gene detection revealed SLC12A1 gene mutation...
July 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/28672763/a-step-by-step-approach-in-differential-diagnosing-of-adrenal-incidentaloma-epinephroma-with-comments-on-the-new-clinical-practice-guidelines-of-the-european-society-of-endocrinology
#7
Frederick-Anthony Farrugia, Evangelos Misiakos, Georgios Martikos, Panagiotis Tzanetis, Anestis Charalampopoulos, Nicolaos Zavras, Dimitrios Sotiropoulos, Nikolaos Koliakos
OBJECTIVES: To present a step by step approach for the diagnosis of adrenal incidentaloma (AI). METHOD: An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented. RESULTS: The majority of the tumours are non-functioning benign adenomas...
June 23, 2017: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
https://www.readbyqxmd.com/read/28458337/outcomes-analysis-of-surgical-and-medical-treatments-for-patients-with-primary-aldosteronism
#8
Kyeong Seon Park, Jung Hee Kim, Ye Seul Yang, A Ram Hong, Dong-Hwa Lee, Min Kyong Moon, Sung Hee Choi, Chan Soo Shin, Sang Wan Kim, Seong Yeon Kim
Patients with aldosterone-producing adenomas are treated using surgery, and patients with idiopathic hyperaldosteronism receive medical treatment using mineralocorticoid receptor antagonists (MRAs). However, the outcomes of surgical and medical treatment for primary aldosteronism (PA) remain unclear. Therefore, we compared the outcomes of surgical and medical treatment for PA and aimed to identify a specific subgroup that might benefit from medical treatment. We identified 269 patients who were treated for PA (unilateral excess: 221 cases; bilateral excess: 48 cases) during 2000-2015 at the Seoul National University Hospital and two other tertiary centers...
April 29, 2017: Endocrine Journal
https://www.readbyqxmd.com/read/28447626/familial-hyperaldosteronism-type-iii
#9
REVIEW
S Monticone, M Tetti, J Burrello, F Buffolo, R De Giovanni, F Veglio, T A Williams, P Mulatero
Primary aldosteronism is the most common form of endocrine hypertension. This disorder comprises both sporadic and familial forms. Four familial forms of primary aldosteronism (FH-I to FH-IV) have been described. FH-III is caused by germline mutations in KCNJ5, encoding the potassium channel Kir3.4 (also called GIRK4). These mutations alter the selectivity filter of the channel and lead to abnormal ion currents with loss of potassium selectivity, sodium influx and consequent increased intracellular calcium that causes excessive aldosterone biosynthesis...
April 27, 2017: Journal of Human Hypertension
https://www.readbyqxmd.com/read/28378050/adrenal-vein-sampling-for-primary-aldosteronism-a-2-week-protocol-for-withdrawal-of-renin-stimulating-antihypertensives
#10
Kevin C Ching, Debbie L Cohen, Douglas L Fraker, Scott O Trerotola
OBJECTIVE: For evaluation of primary aldosteronism, international guidelines recommend a 4-6 week withdrawal of spironolactone, eplerenone, and amiloride prior to adrenal vein sampling (AVS). It is not always feasible to withdraw these drugs in patients with severe hypertension and hypokalemia. We present our experience evaluating the efficacy and clinical outcomes of a 2-week protocol for withdrawal of renin-stimulating antihypertensives prior to AVS. DESIGN: A single-center retrospective review of all patients who underwent AVS for primary aldosteronism between January 2014 and December 2015...
April 4, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28302238/gitelman-syndrome
#11
Qurat Ul Ain Mustafa, Zujaja Hina Haroon, Aamir Ijaz, Muhammad Tanveer Sajid, Muhammad Ayyub
Gitelman syndrome (GS) is the most frequently inherited renal salt-wasting tubulointerstitial disease. It follows variable but usually asymptomatic benign course. We present a rare case of GS that remained clinical enigma. A 22-year male presented with severe episodic fatigue involving all limbs associated with episodes of sinking, palpitations, salt craving, increased thirst and frequent micturition hampering his routine daily activities. Laboratory workup revealed serum potassium, 2.7 mmol/L, serum magnesium, 0...
March 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28293914/a-late-diagnosis-of-primary-aldosteronism
#12
Francesco Zorzi, Oliviero Olivieri, Paolo Brazzarola, Francesca Pizzolo
We report the case of a 41-year-old male patient with juvenile onset refractory hypertension while taking four drugs including a diuretic. Fourteen years before he underwent a complete investigation for secondary hypertension (including the aldosterone to renin ratio-ARR) that was negative. Since that, hypertension control gradually worsened, hypertensive organ damage aggravated and hypokalemia developed in spite of ACE inhibitor treatment. At the re-evaluation ARR was elevated, and the further workup for primary aldosteronism demonstrated an unilateral aldosterone producing adenoma that was surgically removed, with subsequent optimal blood pressure control with two anti-hypertensive drugs...
March 14, 2017: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
https://www.readbyqxmd.com/read/28289181/hypokalemia-and-pendrin-induction-by-aldosterone
#13
Ning Xu, Daigoro Hirohama, Kenichi Ishizawa, Wen Xiu Chang, Tatsuo Shimosawa, Toshiro Fujita, Shunya Uchida, Shigeru Shibata
Aldosterone plays an important role in regulating Na-Cl reabsorption and blood pressure. Epithelial Na(+) channel, Na(+)-Cl(-) cotransporter, and Cl(-)/HCO3(-) exchanger pendrin are the major mediators of Na-Cl transport in the aldosterone-sensitive distal nephron. Existing evidence also suggests that plasma K(+) concentration affects renal Na-Cl handling. In this study, we posited that hypokalemia modulates the effects of aldosterone on pendrin in hyperaldosteronism. Chronic aldosterone infusion in mice increased pendrin levels at the plasma membrane, and correcting hypokalemia in this model almost completely blocked pendrin upregulation...
May 2017: Hypertension
https://www.readbyqxmd.com/read/28287293/-classical-antihypertensive-drugs-diuretics
#14
Viktor László Nagy
The diuretics are essential medicaments of antihypertensive therapy. They reduce blood pressure and cardiovascular events optimally. With increasing doses of thiazides and thiazide analogs do not come further powerful effect of reducing blood pressure or cardiovascular mortality and morbidity, but clearly elevate the side effects. Because of it, the minimum effective dose level and the fixed-dose combination therapy should be preferred. The use these drugs leads to especially positive outcome in elder patients, isolated systolic hypertension, heart failure, after stroke and in black population...
March 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28261922/a-case-of-primary-aldosteronism-caused-by-unilateral-multiple-adrenocortical-micronodules-presenting-as-muscle-cramps-at-rest-the-importance-of-functional-histopathology-for-identifying-a-culprit-lesion
#15
Atsushi Ito, Yuto Yamazaki, Hironobu Sasano, Daisuke Matsubara, Noriyoshi Fukushima, Mio Tamba, Kenichi Tabata, Kentaro Ashizawa, Akihito Takei, Masaru Koizumi, Yasunaru Sakuma, Naohiro Sata, Hisashi Oshiro
Unilateral multiple adrenocortical micronodules (UMNs) constitute a rare subset of primary aldosteronism (PA) characterized by the hypersecretion of aldosterone derived from multiple small nodules in the zona glomerulosa of the unilateral adrenal grand. This case study describes a 49-year-old man with PA and UMNs who presented with muscle cramps at rest due to hypokalemia. The patient had a 6-year history of hypertension treated with antihypertensive drugs. Imaging studies revealed bilateral adrenal nodules as large as 5 mm...
April 2017: Pathology International
https://www.readbyqxmd.com/read/28236585/the-importance-of-genetic-counseling-and-genetic-screening-a-case-report-of-a-16-year-old-boy-with-resistant-hypertension-and-severe-hypokalemia
#16
Ze-Min Kuang, Ying Wang, Jia-Jie Wang, Jing-Hua Liu, Rong Zeng, Qi Zhou, Zhen-Qiu Yu, Long Jiang
Liddle's syndrome, an autosomal dominant form of monogenic hypertension, is characterized by salt-sensitive hypertension with early penetrance, hypokalemia, metabolic alkalosis, suppression of plasma rennin activity and aldosterone secretion, and a clear-cut response to epithelial sodium channel blockers but not spironolactone therapy. Here, we describe the case of a 16-year-old boy patient with resistant hypertension (maintain 170-180/100-110 mm Hg after administration four kinds of antiypertensive drugs) and severe hypokalemia...
March 2017: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28139270/an-unlikely-cause-of-hypokalemia
#17
Jason Hine, Ari Schwell, Norah Kairys
BACKGROUND: Hypokalemia is a common clinical disorder caused by a variety of different mechanisms. Although the most common causes are diuretic use and gastrointestinal losses, elevated cortisol levels can also cause hypokalemia through its effects on the renin-angiotensin-aldosterone system. Cushing's syndrome refers to this general state of hypercortisolemia, which often manifests with symptoms of generalized weakness, high blood pressure, diabetes mellitus, menstrual disorders, and psychiatric changes...
May 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28129247/effectiveness-of-patiromer-in-the-treatment-of-hyperkalemia-in-chronic-kidney-disease-patients-with-hypertension-on-diuretics
#18
Matthew R Weir, Martha R Mayo, Dahlia Garza, Susan A Arthur, Lance Berman, David Bushinsky, Daniel J Wilson, Murray Epstein
OBJECTIVE: Recurrent hyperkalemia frequently limits use of renin-angiotensin-aldosterone system inhibitors (RAASi) in chronic kidney disease (CKD) patients with hypertension, diabetes, and/or heart failure. Patiromer is a sodium-free, nonabsorbed potassium (K)-binding polymer approved by the US Food and Drug Administration for the treatment of hyperkalemia. This post-hoc analysis of OPAL-HK examined the effectiveness and safety of patiromer in reducing serum K in hyperkalemic CKD patients on RAASi, with hypertension, receiving diuretic therapy versus those not on diuretics...
May 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28129245/plasma-aldosterone-level-within-the-normal-range-is-less-associated-with-cardiovascular-and-cerebrovascular-risk-in-primary-aldosteronism
#19
Masahiko Murata, Tetsuhiro Kitamura, Daisuke Tamada, Kosuke Mukai, Shogo Kurebayashi, Tsunehiko Yamamoto, Kunihiko Hashimoto, Reiko D Hayashi, Haruhiko Kouhara, Sachi Takeiri, Yoshitaka Kajimoto, Makoto Nakao, Toshimitsu Hamasaki, Michio Otsuki, Iichiro Shimomura
BACKGROUND: Previous studies showed higher risk of cardiovascular and cerebrovascular (CCV) events in primary aldosteronism compared with essential hypertension, but the patients of these studies were limited to primary aldosteronism patients with high plasma aldosterone concentration (PAC). The introduction of the aldosterone-renin ratio as the screening test for primary aldosteronism led to the recognition of primary aldosteronism patients with normal PAC (nPA). However, there is no information on the risk of primary aldosteronism including nPA...
May 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28123500/effects-of-low-dose-tolvaptan-on-electrolyte-abnormality-and-hemodynamic-parameters-in-a-liver-cirrhosis-associated-portopulmonary-hypertension-patient-a-case-report
#20
Yoshito Ogihara, Norikazu Yamada, Kaoru Dohi, Akimasa Matsuda, Satoshi Ota, Ken Ishikura, Mashio Nakamura, Masaaki Ito
The present study reported a case of portopulmonary hypertension (POPH) that was secondary to underlying liver cirrhosis in a 58-year-old woman, who was successfully treated with low-dose tolvaptan. The patient had suffered from refractory peripheral edema and electrolyte abnormalities, including severe hypokalemia, under the combination therapy of sildenafil, ambrisentan, furosemide and spironolactone. Subsequent to the initiation of low-dose tolvaptan at 3.75 mg/day with concurrent de-escalation of the dose of furosemide, the daily urine volume increased, peripheral edema improved and the serum potassium level increased immediately...
January 2017: Experimental and Therapeutic Medicine
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