Volume 3 Issue 11, November 2007

This, the first of two opposing Viewpoints, sets out the arguments against screening for primary aldosteronism. The author, from the Western General Hospital in Edinburgh, UK, asserts that the majority of individuals with a high aldosterone:renin ratio have a normal plasma aldosterone level. Physicians should, therefore, focus on optimizing the excretion of salt and water in hypertensive patients rather than on expensive tests to detect an aldosterone-secreting adenoma.

In the second of two opposing Viewpoints, these authors from the Greenslopes and Princess Alexandra Hospital Hypertension Units in Brisbane, Australia, describe why, who, and how they screen for primary aldosteronism. They argue that diagnosing (using a stepwise selective approach) and curing or specifically treating aldosterone excess is good for the patient and inexpensive compared with potentially lifelong and less-effective nonspecific antihypertensive therapy.

The bio-incompatible characteristics of standard peritoneal dialysis solutions, such as high glucose concentration and nonphysiologic pH, have spurred the development of a new generation of more-biocompatible solutions. In this overview of available clinical data, the advantages and drawbacks of using fluids that contain amino acids or icodextrin, or that have a neutral pH, are debated. The authors conclude that the new peritoneal dialysis solutions hold great promise for improving ultrafiltration and clinical outcomes.

It is important that care providers recognize that increased blood pressure during gestation increases a woman's chances of developing cardiovascular problems later in life. To that end, authors from the Mayo Clinic have brought together data that support this association. As we lack large-scale studies of prevention strategies, Garovic and Hayman recommend that women who have had hypertensive pregnancies should be carefully monitored after pregnancy for risk factors associated with cardiovascular disease.

Members of the WNK family of novel serine/threonine kinases inhibit secretion of potassium from the kidney via ROMK. Potassium deficiency—a common problem of modern diets—promotes potassium retention by upregulating WNK1. In this Review of data from animal and human studies, Huang and Kuo frame the hypothesis that WNK-mediated potassium retention is accompanied by sodium retention, and thereby contributes to the development of salt-sensitive hypertension.

Acute renal infarction (ARI) is a rare disease that is often misdiagnosed initially because of its nonspecific presentation. In this Case Study, Nasser and colleagues describe a patient with ARI due to a thromboembolism from a cardiac thrombus. They discuss the common presenting symptoms of ARI and comment on the various treatment options that are available.