De rol van primair hyperaldosteronisme in chronisch nierfalen bij de kat

Abstract

Background: In recent years, more cats are diagnosed with primary hyperaldosteronism. Especially if primary hyperaldosteronism is caused by a bilateral idiopatic adrenalhyperplasia. Clinical important symptoms, caused by an aldosterone excess, are arterial hypertension and hypokalemia. These symptoms are also often present in cats with chronic renal failure, the underlying mechanism is unknown. One explanation may be that primary hyperaldosteronism plays a role in the development of these clinical symptoms. If primary hyperaldosteronism plays an important role in the progression of chronic renal failure; an aldosterone-receptor blocker would be of great importance in the treatment of cats with chronic renal failure. If it appears that primary hyperaldosteronism is an initiating factor, the emergence of chronic renal failure by hyperaldosteronism, if diagnosed in time, can be prevented. Hypothesis: Primary hyperaldosteronism plays a role in the progression and initiation of chronic renal failure. Animals: Twenty-two household cats with high creatinine concentration. Methods: Of 22 cats we have measured the renal function, electrolytebalance, aldosterone en renine. We measured the arterial blood pressure and viewed the retina using direct ophtalmoscopie. Results: Of 19 cats, from witch the aldosterone en renineconcentrations are known, 4 cats were diagnosed with primary hyperaldosteronism. These 4 cats have an Aldosterone-Renine Ratio (ARR) above 3.8x10-9. Cat 1 has an a ratio of 4.2x10-9, cat 9 a ratio of 6.3x10-9, cat 18 a ratio of 4.4x10-9 and cat 22 has a ratio of 19.5 x 10-9. Seven cats were found with arterial hypertension. (mean value: 175 mmHg, median: 170 mmHg) In six of these seven cats there were found retinal-abnormalities. Conclusion en clinical importance: With the available data it might be too early to give a prominent role to primary hyperaldosteronism in cats with renal failure. It is therefore necessary to obtain more date and perform additional research. Nevertheless we have found in 4 of 19 cats primary hyperaldosteronism.