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Unmasking primary aldosteronism after kidney transplantation: a case series

Journal of Human Hypertension volume 40, pages 413–416 (2026) Cite this article

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Abstract

Primary aldosteronism is characterized by excess aldosterone production leading to hypertension and hypokalemia. We report three cases of unilateral primary aldosteronism after kidney transplantation. Each patient presented with elevated blood pressure and hypokalemia early posttransplant. Diagnosis was established through elevated aldosterone-to-renin ratios and positive aldosterone suppression tests, and lateralization was determined with selective adrenal venous sampling. Ipsilateral adrenalectomy improved hypokalemia and blood pressure control for all. Notably, two patients with biopsy-confirmed glomerular pathology after kidney transplantation exhibited proteinuria reduction following adrenalectomy.

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Fig. 1: Histology from kidney transplant recipients with primary aldosteronism.
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There was no funding associated with this manuscript.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA

    Mario Funes Hernandez

  2. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Colin Lenihan, Vivek Bhalla & Xingxing S. Cheng

  3. Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA, USA

    Vivek Bhalla

  4. Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA

    Vivek Charu

Authors
  1. Mario Funes Hernandez
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  2. Colin Lenihan
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  3. Vivek Bhalla
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  4. Vivek Charu
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  5. Xingxing S. Cheng
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Contributions

MFH – Conceptualization, methodology, data curation, writing-original draft, writing-reviewing and editing. CL – Conceptualizing, data curation, writing-reviewing and editing. VB – Conceptualization, writing-reviewing and editing. VC – Visualization, writing-reviewing and editing. XSC – Conceptualization, methodology, data curation, writing-review and editing, supervision.

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Correspondence to Xingxing S. Cheng.

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Hernandez, M.F., Lenihan, C., Bhalla, V. et al. Unmasking primary aldosteronism after kidney transplantation: a case series. J Hum Hypertens 40, 413–416 (2026). https://doi.org/10.1038/s41371-026-01153-6

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