[Chronic kidney disease after adrenalectomy in a patient with primary aldosteronism].

We report one case of estimated glomerular filtration rate (eGFR) decline after taking unilateral adrenalectomy due to aldosterone adenoma. A 60-year-old male with 23-year history of hypertension was reported to the endocrinologist due to hypokalemia (serum potassium 3.01 mmol/L). Urine microalbumin/creatinine (ALB/CR) was 70.15 mg/g, serum creatinine was 82 µmol/L and eGFR was 89.79 mL/(min·1.73 m2). Random serum aldosterone was 172.2-203.5 ng/L, and random plasma rennin activity was 0-0.17 µg/(L·h). His captopril challenge test suggested that his aldosterone le-vels were suppressed by 8% (< 30%) and the adrenal enhanced computed tomography scan revealed a left adrenal tumor. The patient was diagnosed with primary hyperaldosteronism (PA), aldosterone adenoma and underwent left laparoscopic adrenalectomy. Histological examination confirmed adrenal cortical adenoma. One week after the operation, his serum creatinine was increased to 127 µmol/L compared with preoperative level; eGFR was 32.34 mL/(min·1.73 m2). His systolic blood pressure (SBP) was 110 mmHg and diastolic blood pressure (DBP) was 60 mmHg (hypotensive drugs discontinued), and serum potassium level was 5.22 mmol/L. At the end of the 2-year follow up, the serum creatinine of this patient remained at 109-158 µmol/L and eGFR fluctuated from 63.28-40.12 mL/(min·1.73 m2). PA is one of the most common causes of secondary hypertension. Several studies have reported renal function deterioration of PA patients after unilateral adrenalectomy, like the patient in this article. Age, preoperative plasma aldosterone concentration, albuminuria and preoperative potassium level might be significant predictors of a decrease in the eGFR. Growing evidence suggests that aldosterone could contribute to structural kidney damage, arterial injury and hemodynamic disorder. At the same time, patients with PA exhibit glomerular hyperfiltration and glomerular vascular hypertension, leading to the misinterpretation of renal function in PA patients as subtle kidney damage may be masked by the glomerular hyperfiltration before treatment. After a unilateral adrenalectomy, glomerular hyperfiltration by aldosterone excess is resolved and renal damage can be unmasked. In conclusion, kidney function deterioration after adrenalectomy can be detected in some patients with PA. Thus, accurate evaluation of kidney function in patients with PA may be essential, especially for those with preoperative risk factors for postoperative renal impairment. After unilateral adrenalectomy, close monitoring of renal function and adequate management are required for PA patients.

Phosphate adsorption characteristics at the sediment-water interface and phosphorus fractions in Nansi Lake, China, and its main inflow rivers.

Phosphorus fractions and phosphate adsorption characteristics of 16 sediments from a shallow freshwater lake (Nansi Lake, China) and its inflow estuaries were investigated. In the present study, the sediment phosphorus is fractionated into exchangeable P (exch-P), Al-P, Fe-P, Ca-P, organic P (OP), inorganic P (IP) and total P (TP). The results show that the total phosphorus (TP) content in the sediments ranges from 571.67 to 1,113.55 mg kg(-1), and calcium bound phosphorus (Ca-P) is the main fraction of IP. The biologically available phosphorus (BAP) ranges from 32.02 to 229.67 mg kg(-1) in the Nansi Lake sediments. Phosphate adsorption on the sediments mainly occurs within 10 h and is completed within 48 h. The content of native adsorbed phosphorus (omega(NAP)) varies greatly from 6.05 to 194.37 mg kg(-1), showing a significant correlation with the total maximal amount of phosphorus adsorbed (TQ(max)). Adsorption efficiency (m) ranges from 574.79 to 3,220.68 l kg(-1) and zero equilibrium phosphorus concentration (C(EPC)) ranges from 0.010 to 0.157 mg l(-1). After the South-to-North Water Diversion Project, the inherent phosphorus present in sediments will be a major threat to the diverted water quality and be a predominant factor determining the trophic status of the lake even if the external load is reduced.