研究者詳細 - 木内　謙一郎

論文 - 木内　謙一郎

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増刊号特集薬の使い方がすぐわかる　泌尿器科処方ガイド 6.内分泌疾患原発性アルドステロン症

木内謙一郎

臨床泌尿器科（株式会社医学書院） 78 （ 4 ） 110 - 113 2024年04月

筆頭著者, 最終著者, 責任著者, ISSN 03852393

【薬の使い方がすぐわかる　泌尿器科処方ガイド】内分泌疾患　原発性アルドステロン症

木内謙一郎

臨床泌尿器科（(株)医学書院） 78 （ 4 ） 110 - 113 2024年04月

筆頭著者, 最終著者, 責任著者, ISSN 0385-2393

＜文献概要＞処方のポイント　●原発性アルドステロン症のスクリーニングや確定診断のための検査の際には,可能な限りレニン・アンジオテンシン系に影響がない薬剤を選択する.また,低カリウム血症を合併する症例では,カリウム製剤による血清カリウム値の補正を十分に行ったうえで検査を実施する.●原発性アルドステロン症の確定診断に至った高血圧の症例では,禁忌がない限りミネラルコルチコイド受容体拮抗薬(MRB)を第一選択とする.

【糖尿病-その病態と,予後決定因子,治療薬が教えてくれること】糖質制限・時間制限食のエビデンスと可能性

山田悟, 木内謙一郎

カレントテラピー（(株)ライフメディコム） 42 （ 2 ） 150 - 154 2024年02月

筆頭著者, 最終著者, 責任著者, ISSN 0287-8445

インスリン発見以前,糖質制限食は唯一の糖尿病治療法であった.インスリン療法の普及とともに20世紀では民間療法として扱われていたが,21世紀になり,血糖改善に最善の食事法とされるに至っている.1型糖尿病,2型糖尿病を問わず,HbA1c改善や低血糖頻度減少や薬剤費軽減を期待可能な食事法であり,わが国でのさらなる普及が期待されている.一方で,時間制限食は概日時計や栄養センシング分子の活性化を介して,体重減少や耐糖能改善,血圧低下などの心血管内分泌代謝の改善効果が示されており,糖尿病,高血圧,メタボリック症候群などの生活習慣病に対する新たな食事法として注目されている.本稿では,糖質制限や時間制限食のエビデンスと可能性を概説する.(著者抄録)

Diurnal variation in the association between the scan frequency of isCGM and CGM metrics: post hoc analysis of the ISCHIA study

Meguro, S. and Sakane, N. and Hosoda, K. and Hirota, Y. and Itoh, A. and Kato, K. and Kodani, N. and Kuroda, A. and Matsuhisa, M. and Miura, J. and Shimada, A. and Tone, A. and Toyoda, M. and Murata, T. and Fukunaga, M. and Kouyama, K. and Tanaka, T. and Tenta, M. and Matsushita, Y. and Takeda, M. and Iseda, I. and Hida, K. and Nagao, T. and Taniguchi, R. and Tanaka, N. and Abe, K. and Hitaka, Y. and Matoba, Y. and Katsuno, T. and Kusunoki, Y. and Fukuda, T. and Shimizu, I. and Tsuchiya, T. and Yagi, K. and Sugiyama, K. and Yamaguchi, S. and Kinouchi, K. and Inaishi, J. and Nakajima, Y. and Mitsuishi, M. and Tanaka, M. and Irie, J. and Saisho, Y. and Itoh, H. and Kawashima, S. and Haisa, A. and Satomura, A. and Oikawa, Y. and Saito, N. and Kimura, M. and Tsuchida, Y. and Shimura, K. and Hoshina, S. and Takagi, S. and Kobayashi, H. and Shen, Z. and Suganuma, A. and Watanabe, T. and Ito, Y. and Suzuki, S. and Kasama, S. and Kasahara, M. and Kouyama, R. and Satoh-Asahara, N. and Miyamoto, Y. and Nishimura, K.

Diabetology International 15 （ 4 ） 828 - 836 2024年

筆頭著者, 最終著者, 責任著者, ISSN 2190-1686

Background and aims: To investigate the association between the frequency of intermittent-scanning continuous glucose monitoring (isCGM) and diurnal variation of time in range (TIR), time above range (TAR), and time below range (TBR), we performed a post hoc analysis of the ISCHIA study, a multicenter, prospective, open-label, randomized crossover study of patients with type 1 diabetes mellitus. Method: Data of 93 people who completed the ISCHIA study were used. We calculated scan frequency, TAR, TIR, and TBR of four approximately 6-h intervals: 6:00–11:59 (morning), 12:00–17:59 (afternoon), 18:00–23:59 (evening), and 0:00–5:59 (night). The correlation between scan frequency and diurnal variation of CGM metrics was analyzed using nonparametric Spearman correlation analysis. Results: More frequent scanning was associated with higher TIR in the afternoon (rho = 0.343, P < 0.001), evening (rho = 0.243, P = 0.019), and night (rho = 0.218, P = 0.036); furthermore, it was associated with lower TAR in the afternoon (rho = -0.275, P = 0.008) and TBR in the evening (rho = -0.235, P = 0.024). Concern about the effect of blood glucose fluctuation on social communication affected the number of scans during the day. Concerns about loneliness and hypoglycemia when alone also influenced the number of nighttime scans. Conclusion: Scan frequency is influenced by psychological factors. Afternoon scans were associated with the highest increase in TIR and decrease in TAR. Evening scans were linked to a reduction in TBR.

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Predictors of the effectiveness of isCGM usage in adults with type 1 diabetes mellitus: post-hoc analysis of the ISCHIA study

Fukunaga, M. and Kouyama, K. and Tanaka, T. and Tenta, M. and Matsushita, Y. and Takeda, M. and Iseda, I. and Hida, K. and Nagao, T. and Taniguchi, R. and Tanaka, N. and Abe, K. and Hitaka, Y. and Matoba, Y. and Katsuno, T. and Kusunoki, Y. and Fukuda, T. and Shimizu, I. and Kodani, N. and Tsuchiya, T. and Yagi, K. and Sugiyama, K. and Itoh, A. and Yamaguchi, S. and Kinouchi, K. and Inaishi, J. and Nakajima, Y. and Mitsuishi, M. and Tanaka, M. and Irie, J. and Saisho, Y. and Itoh, H. and Meguro, S. and Kawashima, S. and Haisa, A. and Satomura, A. and Oikawa, Y. and Shimada, A. and Saito, N. and Kimura, M. and Tsuchida, Y. and Shimura, K. and Hoshina, S. and Takagi, S. and Kobayashi, H. and Shen, Z. and Suganuma, A. and Watanabe, T. and Ito, Y. and Suzuki, S. and Kasama, S. and Kasahara, M. and Tone, A. and Miura, J. and Kouyama, R. and Kato, K. and Kuroda, A. and Matsuhisa, M. and Hirota, Y. and Toyoda, M. and Satoh-Asahara, N. and Sakane, N. and Murata, T. and Miyamoto, Y. and Nishimura, K. and Hosoda, K. and Murata, T.

Diabetology International 15 （ 3 ） 400 - 405 2024年

筆頭著者, 最終著者, 責任著者, ISSN 2190-1686

Aim: The Effect of Intermittent-Scanning Continuous Glucose Monitoring to Glycemic Control Including Hypoglycemia and Quality of Life of Patients with Type 1 Diabetes Mellitus (ISCHIA) study was a randomized, crossover trial that reported the decrease in time below range (TBR) by the use of intermittent-scanning continuous glucose monitoring (isCGM) combined with structured education in adults with type 1 diabetes (T1D) treated by multiple daily injections. The participants were instructed to perform frequent scanning of the isCGM sensor (10 times a day or more) and ingest sugar when impending hypoglycemia is suspected by tracking the sensor glucose levels and the trend arrow. We conducted post-hoc analysis to identify factors affecting difference in TBR (∆TBR), in time in range (∆TIR), and in time above range (∆TAR). Participants and methods: Data from 93 participants who completed the ISCHIA study were used. Multiple regression analyses were performed to identify factors affecting CGM metrics. Results: Pearson’s correlation analysis showed the negative association between log-transformed scan frequency and with ∆TBR (r = − 0.255, P = 0.015), while there was no significant association of log-transformed scan frequency with ∆TIR (r = 0.172, P = 0.102) and ∆TAR (r = 0.032, P = 0.761), respectively. The log-transformed scan frequency was an independent predictor of ∆TBR (Beta = − 7.712, P = 0.022), but not of ∆TIR(Beta = 7.203, P = 0.091) and of ∆TAR (Beta = 0.514, P = 0.925). Conclusions: Our findings suggest that more frequent scanning of isCGM may be beneficial to reduce TBR in T1D adults.

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Predicting the laterality of the autonomous aldosterone production from adrenal vein sampling

Kinouchi, K. and Hayashi, K.

Hypertension Research （Springer Science and Business Media LLC） 47 （ 2 ） 543 - 544 2024年

筆頭著者, 最終著者, 責任著者, ISSN 1348-4214

Association between Renal Sinus Fat and Cardiometabolic and Renin-Angiotensin System Parameters in Primary Aldosteronism

Mitsuno, R. and Kaneko, K. and Nakamura, T. and Kojima, D. and Mizutani, Y. and Azegami, T. and Yamaguchi, S. and Yamada, Y. and Jinzaki, M. and Kinouchi, K. and Yoshino, J. and Hayashi, K.

Journal of the Endocrine Society （The Endocrine Society） 8 （ 1 ） bvad154 2023年12月

筆頭著者, 最終著者, 責任著者, ISSN 24721972

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Context</jats:title>
<jats:p>Renal sinus fat (RSF) accumulation is associated with cardiometabolic diseases, such as obesity, diabetes, hypertension, and chronic kidney disease. However, clinical implications of RSF in primary aldosteronism (PA) remain unclear.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Objective</jats:title>
<jats:p>We aimed to investigate relationships between RSF volume and key cardiometabolic and renin-angiotensin system (RAS) parameters in PA patients and clarify the differences in these relationships between unilateral and bilateral subtypes.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We analyzed data obtained from well-characterized PA patients that involved 45 unilateral (median age: 52 years; 42.2% men) and 92 bilateral patients (51 years; 42.4% men).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>RSF volume normalized by renal volume (RSF%) was greater in the unilateral group than in the bilateral group (P < .05). RSF% was greater in men than in women (P < .05). RSF% positively correlated with parameters related to cardiometabolic risk, including age, body mass index, visceral fat volume, creatinine, triglycerides/high-density lipoprotein cholesterol ratio, uric acid, fasting glucose, and C-reactive protein regardless of PA subtypes (all P < .05). Intriguingly, RSF% positively correlated with plasma aldosterone concentration (PAC), aldosterone-to-renin ratio, and intact parathyroid hormone (iPTH) (all P < .05) in bilateral patients but did not correlate with RAS parameters and even showed an opposite trend in unilateral patients. In subgroup analyses by sex, these distinctions became more evident in women. After adjustment for potential confounders, RSF% remained positively correlated with PAC and iPTH in bilateral patients.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Our results indicate that RSF accumulation is involved in cardiometabolic dysfunction associated with PA. However, there were distinct correlations between RSF volume and RAS parameters according to sex and PA subtypes.</jats:p>
</jats:sec>

内分泌障害を伴ったPOEMS症候群の一例

増田佳奈子, 小林佐紀子, 木内謙一郎, 中村俊文, 藤井高幸, 清水隆之, 伊藤裕, 林香

日本内分泌学会雑誌（(一社)日本内分泌学会） 99 （ 2 ） 614 - 614 2023年10月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

Adipocyte NMNAT1 expression is essential for nuclear NAD+ biosynthesis but dispensable for regulating thermogenesis and whole-body energy metabolism

Yamaguchi S, Kojima D, Iqbal T, Kosugi S, Franczyk MP, Qi N, Sasaki Y, Yaku K, Kaneko K, Kinouchi K, Itoh H, Hayashi K, Nakagawa T, Yoshino J

Biochemical and Biophysical Research Communications （Elsevier BV） 674 162 - 169 2023年09月

筆頭著者, 最終著者, 責任著者, ISSN 0006-291X

Nicotinamide adenine dinucleotide (NAD+) functions as an essential cofactor regulating a variety of biological processes. The purpose of the present study was to determine the role of nuclear NAD+ biosynthesis, mediated by nicotinamide mononucleotide adenylyltransferase 1 (NMNAT1), in thermogenesis and whole-body energy metabolism. We first evaluated the relationship between NMNAT1 expression and thermogenic activity in brown adipose tissue (BAT), a key organ for non-shivering thermogenesis. We found that reduced BAT NMNAT1expression was associated with inactivation of thermogenic gene program induced by obesity and thermoneutrality. Next, we generated and characterized adiponectin-Cre-driven adipocyte-specific Nmnat1 knockout (ANMT1KO) mice. Loss of NMNAT1 markedly reduced nuclear NAD+ concentration by approximately 70% in BAT. Nonetheless, adipocyte-specific Nmnat1 deletion had no impact on thermogenic (rectal temperature, BAT temperature and whole-body oxygen consumption) responses to β-adrenergic ligand norepinephrine administration and acute cold exposure, adrenergic-mediated lipolytic activity, and metabolic responses to obesogenic high-fat diet feeding. In addition, loss of NMNAT1 did not affect nuclear lysine acetylation or thermogenic gene program in BAT. These results demonstrate that adipocyte NMNAT1 expression is required for maintaining nuclear NAD+ concentration, but not for regulating BAT thermogenesis or whole-body energy homeostasis.

1型糖尿病モデルマウスにおける腎臓の代謝変容から見た腎障害進展機序の解明

押田卓磨, 宮下和季, 久保亜紀子, 中村俊文, 木内謙一郎, 伊藤裕, 林香

日本高血圧学会総会プログラム・抄録集（(NPO)日本高血圧学会） 45回 371 - 371 2023年09月

筆頭著者, 最終著者, 責任著者

Intermittent Fasting Sustainably Improves Glucose Tolerance in Normal Weight Male Mice Through Histone Hyperacetylation

Endo, S. and Uto, A. and Miyashita, K. and Sato, M. and Inoue, H. and Fujii, K. and Hagiwara, A. and Ryuzaki, M. and Oshida, T. and Kinouchi, K. and Itoh, H.

Journal of the Endocrine Society （The Endocrine Society） 7 （ 7 ） bvad082 2023年06月

筆頭著者, 最終著者, 責任著者, ISSN 24721972

<jats:title>Abstract</jats:title>
<jats:p>To explore the mechanism by which intermittent fasting (IF) exerts prolonged effects after discontinuation, we examined mice that had been subjected to 4 cycles of fasting for 72 hours and ad libitum feeding for 96 hours per week (72hIF), followed by 4 weeks of ad libitum feeding, focusing on expression of genes for lipid metabolism in the skeletal muscle and histone acetylation in the promoter region. The 72hIF regimen resulted in metabolic remodeling, characterized by enhanced lipid utilization and mitochondrial activation in the muscle. This long-term IF (72hIF) caused stronger metabolic effects than alternate day fasting (24hIF) wherein fasting and refeeding are repeated every 24 hours. Upregulation of lipid oxidation genes and an increase in oxygen utilization were sustained even at 4 weeks after discontinuation of 72hIF, associated with histone hyperacetylation of the promoter region of uncoupling protein 3 (Ucp3) and carnitine palmitoyl transferase 1b (Cpt1b) genes. An increase in leucine owing to fasting-induced muscle degradation was suggested to lead to the histone acetylation. These findings support the previously unappreciated notion that sustainable promotion of histone acetylation in lipid oxidation genes of the muscle and adipose tissues during and after IF may contribute to sustained metabolic effects of IF.</jats:p>

The circadian clock CRY1 regulates pluripotent stem cell identity and somatic cell reprogramming

Sato, S. and Hishida, T. and Kinouchi, K. and Hatanaka, F. and Li, Y. and Nguyen, Q. and Chen, Y. and Wang, P.H. and Kessenbrock, K. and Li, W. and Izpisua Belmonte, J.C. and Sassone-Corsi, P.

Cell Reports （Elsevier BV） 42 （ 6 ） 112590 - 112590 2023年05月

筆頭著者, 最終著者, 責任著者, 査読有り, ISSN 22111247

Distinct metabolic conditions rewire circadian-clock-controlled signaling pathways leading to the de novo construction of signal transduction networks. However, it remains unclear whether metabolic hallmarks unique to pluripotent stem cells (PSCs) are connected to clock functions. Reprogramming somatic cells to a pluripotent state, here we highlighted non-canonical functions of the circadian repressor CRY1 specific to PSCs. Metabolic reprogramming, including AMPK inactivation and SREBP1 activation, was coupled with the accumulation of CRY1 in PSCs. Functional assays verified that CRY1 is required for the maintenance of self-renewal capacity, colony organization, and metabolic signatures. Genome-wide occupancy of CRY1 identified CRY1-regulatory genes enriched in development and differentiation in PSCs, albeit not somatic cells. Last, cells lacking CRY1 exhibit differential gene expression profiles during induced PSC (iPSC) reprogramming, resulting in impaired iPSC reprogramming efficiency. Collectively, these results suggest the functional implication of CRY1 in pluripotent reprogramming and ontogenesis, thereby dictating PSC identity.

術前画像診断に苦慮した脂肪・骨髄化生を伴うコルチゾール産生腺腫の一例

浅井愛未, 小林佐紀子, 木内謙一郎, 中村俊文, 水谷洋佑, 宮下和季, 澤原夢, 乃村元子, 武田利和, 上野彰久, 新井恵吏, 真杉洋平, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 99 （ 1 ） 393 - 393 2023年05月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

Cushing症候群精査中に妊娠が判明し妊娠17週で副腎切除術を行った症例

水谷洋佑, 小林佐紀子, 木内謙一郎, 中村俊文, 丸木友美, 乃村元子, 武田利和, 玉井順子, 池ノ上学, 田中守

日本内分泌学会雑誌（(一社)日本内分泌学会） 99 （ 1 ） 394 - 394 2023年05月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

体内時計の同調による代謝恒常性と肥満

岩原彰秀, 加藤恭介, 木内謙一郎, 伊藤裕

Precision medicine = プレシジョンメディシン / 「Precision medicine」編集委員会編（東京 : 北隆館） 6 （ 5 ） 346 - 349 2023年05月

筆頭著者, 最終著者, 責任著者, ISSN 24343625

CiNii Research

クッシング症候群を併発した男性ホルモン産生副腎腫瘍の一例

遊木一成, 小林佐紀子, 木内謙一郎, 中村俊文, 水谷洋佑, 宮下和季, 増田佳奈子, 乃村元子, 武田利和, 上野彰久, 新井恵吏, 大喜多肇, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 99 （ 1 ） 394 - 394 2023年05月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

【体内時計のprecision medicine】体内時計の同調による代謝恒常性と肥満

岩原彰秀, 加藤恭介, 木内謙一郎, 伊藤裕

Precision Medicine （(株)北隆館） 6 （ 5 ） 346 - 349 2023年05月

筆頭著者, 最終著者, 責任著者, ISSN 2434-3625

昼夜の明暗周期に同期しながらも,自律的で固有の約24時間周期のリズムを生体は有しており,概日リズムと呼ばれる。概日リズムは生体時計を中心とする転写翻訳フィードバック機構を基軸に,代謝恒常性を維持している。近年の研究から,夜勤や深夜の食事が概日リズムの乱れを通じて,肥満の原因となることが明らかになってきた。これまで肥満に関わる知見の多くが,カロリー摂取量やエネルギー消費量に焦点が当てられてきたが,食事摂取や空腹のタイミングが重要な役割を果たすことが分かってきている。本項では,概日リズムの同調因子としての食事のタイミングと内分泌代謝リズムの肥満の病態への関与を概説する。(著者抄録)

テストステロン産生副腎腫瘍から二次性多血症を発症した1例

新藤隆英, 松木絵里, 木内謙一郎, 片岡圭亮

臨床血液（(一社)日本血液学会-東京事務局） 64 （ 4 ） 301 - 301 2023年04月

筆頭著者, 最終著者, 責任著者, ISSN 0485-1439

PS-B07-4: ADMINISTRATION OF AMINO ACIDS PROVOKES EXPRESSION OF PRO-FIBROTIC GENES IN MURINE CULTURED FIBROBLAST CELLS

Takuma Oshida, Kazutoshi Miyashita, Akiko Kubo, Masaaki Sato, Kentaro Fujii, Masaki Ryuzaki, Asuka Uto, Toshifumi Nakamura, Kenichiro Kinouchi, Sakiko Kobayashi, Hiroshi Ito

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e371 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>Diabetic kidney disease (DKD) has been the most common cause of end-stage renal disease (ESRD) which leads to hemodialysis for more than 20 years in Japan. Various reports have been published on the mechanisms underlying the progression of DKD, however, many details remain unclear. We investigated the mechanisms underlying the progression of renal fibrosis and kidney injury in hyperglycemia from the viewpoint of metabolic alteration in the kidney by using streptozotocin-treated mice (STZ mice).</jats:p> </jats:sec> <jats:sec> <jats:title>Design/Methods:</jats:title> <jats:p>8 weeks old ICR mice were treated with streptozotocin (200 mg/kg intra-peritoneally), to produce type 1 diabetes mellitus model mice. The kidneys of those mice were collected 4 weeks after STZ treatment and examined for metabolites that were altered in the kidneys of STZ mice by metabolome analysis. Amino acids that were increasing in the kidneys of STZ mice were administered to L929 murine fibroblast cells, and expression of pro-fibrotic genes were examined.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>STZ-treatment caused progression of renal fibrosis in mice under both low- and high-protein diets. Metabolome analysis of the kidneys in STZ mice showed marked alterations of amino acids in the kidneys. Increased levels of branched chain amino acids (BCAAs) such as valine and leucine were observed. Among these amino acids, leucine administration to L929 cells resulted in increased expression of genes promoting renal fibrosis.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Alterations of BCAAs in the kidneys due to hyperglycemia in STZ mice may affect progression of renal fibrosis and kidney injury. We are now investigating the mechanism by which BCAAs contribute to renal fibrosis.</jats:p> </jats:sec>

PS-R07-5: A CASE OF PRIMARY ALDOSTERONISM WITH DECLINED GLOMERULAR FILTRATION RATE AFTER ADRENALECTOMY

Hikari Kohmoto, Sakiko Kobayashi, Kazutoshi Miyashita, Kenichiro Kinouchi, Toshifumi Nakamura, Yosuke Mizutani, Toshikazu Takeda, Mototsugu Oya, Masashi Tamura, Seishi Nakatsuka, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e511 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Primary aldosteronism (PA) has been known to cause organ damage, such as renal and cardiovascular disorders more frequently than essential hypertension (EH), independently of blood pressure. Among renal disorders, albuminuria is more prevalent in patients with PA than EH, while GFR tends to be higher in PA due to glomerular hyperfiltration. Surgical and medical treatments for PA correct these effects of excess aldosterone, which sometimes uncover preexisting chronic kidney disease (CKD). Here we present a case of PA with CKD who manifested decline of glomerular filtration rate (GFR) and overt renal failure following resection of aldosterone-producing adenoma.</jats:p> </jats:sec> <jats:sec> <jats:title>Case report:</jats:title> <jats:p>A 53-year-old woman was diagnosed with hypertension at the age of 40. Her primary care physician started treatment with a calcium channel blocker (CCB). At the age of 49, she was diagnosed with Sjogren's syndrome (SS). Blood tests revealed severe hypokalemia and eGFR of 50 mL/min/1.73m2, while 24-hr urine collection showed urinary protein of 0.5 g per day. SS was suspected to underlie her renal disease. A renal biopsy was performed, and suggested nephrosclerosis and IgA nephropathy. On the other hand, a 11mm-sized tumor in the left adrenal gland was discovered during the investigation of secondary hypertension. PA was confirmed based on active renin concentration (ARC) of 4.3 pg/mL, plasma aldosterone concentration (PAC) of 342 pg/mL, an aldosterone-to-renin ratio of 79.5 (> 40), and 24-hr urinary aldosterone levels of 15.9 μg per day under the adequate salt-loaded condition. Adrenal venous sampling yielded aldosterone hypersecretion from the left adrenal vein, which indicated aldosterone-producing adenoma. Laparoscopic partial left adrenalectomy was performed and fully normalized ARC, PAC, and urinary aldosterone levels, which indicated biochemical cure of PA. Consequently, blood pressure had been well controlled with a single CCB. However, while her preoperative serum creatine level ranged from 0.9 to 1.1 mg/dL and eGFR was around 40–50 mL/min/1.73m2, her postoperative serum creatine level increased to 1.4 to 1.9 mg/dL and eGFR decreased to 25 to 35 mL/min/1.73m2 on average. In contrast, urinary protein level improved to less than 0.1 g/day, suggesting that post-treatment increase in creatine level indicated unveiling CKD rather than deterioration of renal function.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>PA treatment may unmask CKD through improving glomerular hyperfiltration from aldosterone excess.</jats:p> </jats:sec>

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