Key result
RAAS withdrawal unmasks primary aldosteronism in resistant hypertension despite normal potassium and renin.
Why the study?
Recognizing primary aldosteronism can be substantially complicated by concomitant chronic kidney disease because altered RAAS regulation, antihypertensive therapy, and absent typical laboratory features may create an atypical profile and delay diagnosis.
Case Report (n=1)
No
Standard screening criteria for primary aldosteronism have limitations in patients with chronic kidney disease and resistant hypertension, necessitating comprehensive evaluation when atypical features like normokalemia and non-suppressed renin are present.
Answers are grounded in this paper and cite their sources.
Standard screening criteria may miss aldosterone-producing adenomas in CKD; leaves open whether expanded evaluation improves outcomes in resistant hypertension.
Primary aldosteronism is a common cause of secondary arterial hypertension; however, its recognition may be substantially complicated by concomitant chronic kidney disease. Altered regulation of the renin-angiotensin- aldosterone system (RAAS), the effects of antihypertensive therapy, and the absence of typical laboratory features may create an atypical diagnostic profile and delay diagnosis. This article presents a clinical case of primary aldosteronism in a young patient with chronic kidney disease and resistant arterial hypertension, characterized by the absence of hypokalemia and by non-suppressed renin at the initial evaluation. After confirmatory testing and withdrawal of therapy affecting the RAAS, adrenalectomy was performed, and morphological and immunohistochemical examination confirmed an aldosterone-producing adenoma. This case illustrates the limitations of standard screening criteria and highlights the need for comprehensive interpretation of clinical, laboratory, and morphological findings when primary aldosteronism is suspected in patients with chronic kidney disease.
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Gabibullaev et al. (2026) conducted a case report in Primary aldosteronism, chronic kidney disease, and resistant arterial hypertension (n=1). Adrenalectomy after withdrawal of RAAS-interfering therapy and confirmatory testing was evaluated on Histopathological and immunohistochemical confirmation of aldosterone-producing adenoma. Adrenalectomy after RAAS therapy withdrawal confirmed an aldosterone-producing adenoma in 1 CKD patient with resistant hypertension despite initially non-suppressed renin and normal potassium.
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