Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

634 Glomerular Diseases Glucocorticoid-Remediable Aldosteronism

■Minimal Change Disease: Patients remaining in remission of NS

never develop renal failure; Up to 10% adults develop episodes acute

renal failure of hemodynamic nature responding to volume removal.

■Focal glomerulosclerosis: If remain with NS most over 5–10 years

develop renal failure.

■IgA Nephropathy: Excellent for patients without risk factors for pro-

gression. Progression to renal failure in 10% at 10 yrs, >30% at 20

yrs.

■Poststreptococcal glomerulonephritis: Most adults have good prog-

nosis, some residual HBP or proteinuria, renal failure rare.

■Rapidly Progressive GN:

➣Anti-GBM: responds well if renal function is not greatly reduced

at the start of Rx

➣ANCA+: responds well to Rx often even if patients present with

severe renal failure

➣Immune Complex patients follow prognosis of the basic disease.

Glucocorticoid-Remediable Aldosteronism.................

MICHEL BAUM, MD

history & physical

■Hypertension with family history of hypertension

tests

■Hypokalemic alkalosis

■Elevated plasma aldosterone

differential diagnosis

■Autosomal dominant disease due to translocation resulting in hybrid

mutant gene where aldosterone synthase is regulated by ACTH

■Distinguish from other causes of hypertension.

management

■Low-salt diet

■Control hypertension.

specific therapy

■Glucocorticoid therapy to suppress ACTH

follow-up

■To follow blood pressure

complications and prognosis

■Dependent on blood pressure control