Şebnem BURHAN, Aslıhan PEKMEZCİ, Aykut ÇELİK, Mutlu NİYAZOĞLU, Esra HATİPOĞLU
İstanbul Medical Journal - 2026;27(3):252-258
Introduction: A transient decline in the estimated glomerular filtration rate (eGFR) is frequently observed following adrenalectomy for primary aldosteronism (PA), reflecting the unmasking of aldosterone-mediated renal injury previously concealed by glomerular hyperfiltration. The temporal pattern of this decline and its associated preoperative predictors remain poorly characterized. Methods: We retrospectively analyzed 38 consecutive patients with confirmed PA who underwent unilateral adrenalectomy. Serial changes in eGFR and serum creatinine were evaluated using the Friedman test with Durbin-Conover post-hoc comparisons. Correlations between postoperative renal function and preoperative clinical and biochemical variables were assessed using Spearman's rank correlation and the Mann-Whitney U test. Results: A statistically significant overall difference in eGFR was observed during the first three postoperative months ( chi2: 9.04, p=0.03), driven by a significant decline at month 3 relative to both the preoperative baseline (p=0.03) and postoperative day 1 (p=0.003). When the 6-month measurement was incorporated, the overall difference was no longer significant ( chi2: 6.52, p=0.16). The eGFR decline at month 3 was significantly more pronounced in patients with spontaneous hypokalemia (-22.2% vs. -4.76%, p=0.04). Month 6 eGFR was negatively correlated with baseline aldosterone concentration, aldosterone-to-renin ratio, and age, and was positively correlated with preoperative eGFR and systolic blood pressure. Conclusion: Adrenalectomy for PA was associated with a transient decline in eGFR at postoperative month 3, with values approaching baseline by month 6, and with no evidence of persistent deterioration. Spontaneous hypokalemia and a higher aldosterone burden identify patients at greater risk of postoperative decline in renal function.
