Korean J Nephrol.  1997 Mar;16(1):162-166.

A Case of Primary Aldosteronism, Nephrotic Syndrome and Chronic Renal Failure: A Diagnostic Dilemma

• Sung JR
• Song KI
• Kim JH
• Cha MK
• Lee EY
• Park MS
• Han DC
• Jin SY
• Hwang SD
• Moon C
• Lee HB

Abstract

Primary aldosteronism is characterized by hypertension, hypokalemia, low plasma renin activity (PRA) and elevated plama aldosterone (PA) level. Primary aldosteronism is suspected in patients with hypertension and unexplained hypokalemia. In chronic renal failure(CRF), however, renin-angiotensin-aldosterone axis is altered by renal disease per se, antihyppertensive drugs used and volume status. Therefore, it is difficult to diagnose primary aldosteronism in CRF on the basis of serum potassium, PRA and PA level. Recently, we experienced a case of primary aldosteronism associated with nephrotic syndrome and CRF. The patient was a 49 years old woman who presented with 10 year old history of high blood pressure and general weakness of one year's duration. Her initial serum creatinine was 7.3mg/dL and serum potassium 2.6mEq/L. PRA was decreased and PA was markedly increased. Persistent hypokalemia urged to evaluate adrenal gland in this case. The round mass was found in left adrenal gland and it was surgically removed. CRF and nephrotic syndrome can alter serum potassium and PRA and there lies the diagnostic dilemma for primary aldosteronsim. It will be well to consider associated primary alodsteronism in a patient with CRF and persistent hypokalemia.

Keyword

Primary Aldosteronism; Chronic Renal Failure; Nephrotic Syndrome; Hypokalemia

MeSH Terms

Adrenal Glands
Aldosterone
Axis, Cervical Vertebra
Child
Creatinine
Female
Humans
Hyperaldosteronism*
Hypertension
Hypokalemia
Kidney Failure, Chronic*
Middle Aged
Nephrotic Syndrome*
Plasma
Potassium
Renin
Aldosterone
Creatinine
Potassium
Renin