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2016 ; 7
(5
): 101-11
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Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology
assumptions, clinical aspects and implications for management
#MMPMID26981183
Sousa AG
; Cabral JV
; El-Feghaly WB
; de Sousa LS
; Nunes AB
World J Diabetes
2016[Mar]; 7
(5
): 101-11
PMID26981183
show ga
Patients with diabetes mellitus (DM) frequently develop electrolyte disorders,
including hyperkalemia. The most important causal factor of chronic hyperkalemia
in patients with diabetes is the syndrome of hyporeninemic hypoaldosteronism
(HH), but other conditions may also contribute. Moreover, as hyperkalemia is
related to the blockage of the renin-angiotensin-aldosterone system (RAAS) and HH
is most common among patients with mild to moderate renal insufficiency due to
diabetic nephropathy (DN), the proper evaluation and management of these patients
is quite complex. Despite its obvious relationship with diabetic nephropathy, HH
is also related to other microvascular complications, such as DN, particularly
the autonomic type. To confirm the diagnosis, plasma aldosterone concentration
and the levels of renin and cortisol are measured when the RAAS is activated. In
addition, synthetic mineralocorticoid and/or diuretics are used for the treatment
of this syndrome. However, few studies on the implications of HH in the treatment
of patients with DM have been conducted in recent years, and therefore little, if
any, progress has been made. This comprehensive review highlights the findings
regarding the epidemiology, diagnosis, and management recommendations for HH in
patients with DM to clarify the diagnosis of this clinical condition, which is
often neglected, and to assist in the improvement of patient care.
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