RESUMO
Tubular functions and the state of renal parenchyma were evaluated in 45 patients with primary aldosteronism (PA) in order to assess morphological and functional characteristics of PA-associated endocrine nephropathy. Data on acid excretion and concentration activities were compared to morphologic findings in renal biopsy specimens, obtained at adrenalectomy. It is demonstrated that endocrine nephropathy may be manifested clinically in two ways: 1) increased secretion combined with a reversibly depressed maximum osmotic urinary concentration; and 2) persistent depression of both functions. The first variant can be seen in cases of high aldosteronemia, marked hypokalemia and recent disease. The morphological substrate of these disorders is hypokalemic tubulopathy, reflected in tubular epithelium vacuole dystrophy of varying degrees. The other variant is seen in cases of moderate aldosteronemia and hypokalemia and long duration of the disease, involving severe hypertension. The morphologic substrate of these tubular disorders is nephropathy with a marked tubulo-interstitial component (chronic tubulo-interstitial nephritis).
