肾移植术后原发性醛固酮增多症二例报告并文献复习  

Case report and literature review of primary aldosteronism after kidney transplantation

作　　者：董文波 胡小鹏[1] 任亮[1] 唐浩[1] 龚连 Dong Wenbo;Hu Xiaopeng;Ren Liang;Tang Hao;Gong Lian(Department of Urology,Affiliated Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,100020

出　　处：《中华器官移植杂志》2020年第8期487-491,共5页Chinese Journal of Organ Transplantation

摘　　要：目的了解肾移植术后原发性醛固酮增多症的临床特点,提高对其认识和临床诊疗水平。方法回顾性分析2例肾移植术后原发性醛固酮增多症的病例资料,结合相关文献进行总结和分析。结果2例受者在慢性肾脏病期均无明显表现,而在肾移植后出现高血压伴持续性低钾血症,一般降压药物无疗效,口服补钾治疗效果欠佳。排除高血压和低钾血症的常见原因后对受者进行了原发性醛固酮增多症的相关检查。2例受者的血浆醛固酮及醛固酮肾素比大幅升高,血浆肾素活性受到抑制,腹部CT检查显示肾上腺单侧腺瘤。2例受者均接受腹腔镜肾上腺切除术,术后血钾恢复正常,血压控制明显改善。结论(1)肾移植术后高血压伴持续性低钾血症应考虑到原发性醛固酮增多症的可能;(2)腹腔镜下肾上腺切除术能够有效治疗肾移植后单侧原发性醛固酮增多症。Objective To explore the clinical characteristics of primary aldosteronism and improve its diagnosis and treatment after kidney transplantation.Methods For two patients with primary aldosteronism after kidney transplantation,clinical data were retrospectively analyzed in conjunctions with the relevant literature.Results Both of them showed no obvious manifestations in the period of chronic kidney disease.However,sustained hypertension with hypokalemia occurred after transplantation.Conventional antihypertensive agents and oral potassium supplement demonstrated a poor efficacy.They were examined for primary aldosteronism after excluding common causes of hypertension and hypokalemia.The ratio of plasma aldosterone and aldosterone renin were significantly elevated.Plasma renin activity became suppressed and abdominal computed tomography(CT)hinted at unilateral adrenal adenoma.Both of them underwent laparoscopic adrenalectomy.Then blood potassium level normalized and blood pressure was under control.Conclusions The possibility of primary aldosteronism should be considered in patients with persistent hypertension and hypokalemia after kidney transplantation.And laparoscopic adrenalectomy can effectively treat unilateral primary aldosteronism.

关 键 词：肾移植 原发性醛固酮增多症 高血压 低钾血症 

分 类 号：R699.2[医药卫生—泌尿科学] R586.24[医药卫生—外科学]