Diagnostic challenges of primary aldosteronism in a patient with chronic kidney disease and resistant arterial hypertension: a case report

Primary aldosteronism is a common cause of secondary arterial hypertension; however, its recognition may be substantially complicated by concomitant chronic kidney disease. Altered regulation of the renin-angiotensin- aldosterone system (RAAS), the effects of antihypertensive therapy, and the absence of typical laboratory features may create an atypical diagnostic profile and delay diagnosis. This article presents a clinical case of primary aldosteronism in a young patient with chronic kidney disease and resistant arterial hypertension, characterized by the absence of hypokalemia and by non-suppressed renin at the initial evaluation. After confirmatory testing and withdrawal of therapy affecting the RAAS, adrenalectomy was performed, and morphological and immunohistochemical examination confirmed an aldosterone-producing adenoma. This case illustrates the limitations of standard screening criteria and highlights the need for comprehensive interpretation of clinical, laboratory, and morphological findings when primary aldosteronism is suspected in patients with chronic kidney disease.

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