Abstract: SA-PO950

The “Conn” Artist: An Unlikely Cause of Post-Kidney Transplantation Hypertension

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Lakhani, Laila S., University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Edwards, Angelina, University of Texas at Houston Health Science Center, Houston, Texas, United States
Background

Hypertension among the post-renal transplant population is largely due to pre-existent essential hypertension in end stage renal disease (ESRD). Other transplant-specific causes of hypertension include the use of Calcineurin inhibitors and Corticosteroids, Renal artery stenosis or Graft Versus Host Disease. Secondary causes of hypertension are rarely reported in the literature. We report an interesting case of a patient with a non-secretory adrenal adenoma pre-transplant, which became functional post-transplant, leading to resistant hypertension and metabolic derangements.

Methods

60 year old female with ESRD secondary to hypertension and diabetes mellitus type 2, underwent evaluation for transplant at our Center. Abdominal imaging revealed a 8 mm left adrenal nodule, however biochemical evidence for a secretory adenoma was negative. She underwent a deceased donor renal transplant, with basiliximab induction and maintenance immunosuppression with cyclosporine, mycophenolate mofetil and prednisone. She had excellent allograft function with nadir creatinine of 1.4 mg/dL but was noted to have uncontrolled blood pressures, despite maximum doses of 5 antihypertensive agents. Laboratory parameters were significant for hypokalemia and metabolic alkalosis. A workup for secondary causes of hypertension was pursued (Table 1). Repeat abdominal imaging at this time showed an enlarged left adrenal adenoma, 1.3x1.9 cm. Labs showed elevated aldosterone levels and adrenal vein sampling localized the secretion to the left adrenal gland (Left: 979ng/dL vs Right: 18 ng/dL). She was started on an aldosterone antagonist with only mild improvement of her blood pressure, subsequently requiring a left adrenalectomy. Post- surgery, she had complete resolution of hypokalemia and stability of her blood pressure, requiring minimal antihypertensive therapy.

Conclusion

Hypokalemia and resistant hypertension from primary hyperaldosteronism can be easily masked in the ESRD population. Although it remains a common problem, medically refractory hypertension post renal transplant should prompt a work up for secondary causes, including hyperaldosteronism.

Table 1: Laboratory findings pre and post-Transplant.
 Pre-TransplantPost-Transplant
Aldosterone/PRA ratio22310
Metanephrines392085
Cortisol11.713.9