PRIMARY HYPERALDOSTERONISM CAUSING POSTTRANSPLANTATION HYPERTENSION -LOCALIZATION BY ADRENAL VEIN SAMPLING

A 58-year-old man with end-stage renal disease who had received a cada veric renal transplant presented with persistent hypertension and hypo kalemia. Allograft renal artery stenosis, rejection, and cyclosporine effects were excluded. Hypokalemia persisted despite potassium supplem entation and antihypertensive medications with hyperkalemic effects. T he biochemical findings of primary hyperaldosteronism with a normal ad renal anatomy imaged by magnetic resonance imaging (MRI) necessitated adrenal vein sampling to lateralize a left adrenal adenoma. His hypoka lemia was cured by the removal of the adenoma, and his blood pressure (BP) control was easily achieved with a less complex regimen of antihy pertensives. We suggest that the concomitant existence of resistant hy pokalemia and posttransplantation hypertension, especially in the cycl osporine era, should stimulate a search for hyperaldosteronism; once t ransplant renal artery stenosis has been excluded, the patient should be investigated for primary hyperaldosteronism. When imaging studies f ail to show adrenal pathology, adrenal vein sampling will likely do so . (C) 1998 by the National Kidney Foundation, Inc.