case_images: PMC10578373_01
case_images: Clinical course of the present case. Discontinuation of angiotensin II receptor blocker (ARB) and mineralocorticoid receptor antagonist (MRA) led to an exacerbation of proteinuria, probably due to diabetes-related nephropathy. Administration of eplerenone or esaxerenone increased both active renin concentration (closed circles with dashed lines, bottom panel) (ARC) and plasma aldosterone concentration (open circles with solid lines, bottom panel) (PAC). On the contrary, addition of atenolol decreased both ARC and PAC. However, the co-administration of azilsartan decreased proteinuria (gray squares, bottom panel) along with a further decrease in PAC, although MRA and atenolol based on nifedipine administration did not reduce proteinuria. Increased serum albumin levels (open squares with solid lines) correlated with decreased blood pressure and azilsartan co-administration, although single use of eplerenone or esaxerenone did not induce this effect. Low-density lipoprotein cholesterol levels (closed squares with dashed lines) did not decrease during single MRA administration (third upper panel). Furthermore, the estimated glomerular filtration rate (eGFR) (gray squares, first upper panel) decreased gradually even after MRA (eplerenone or esaxerenone) administration; however, it was preserved following 10 mg/day azilsartan administration. Systolic blood pressure (open circles, first upper panel) gradually decreased below 140 mmHg. Moreover, serum potassium levels (open circle with lines, second upper panel) were preserved within reference range and HbA1c levels (closed circles with dashed lines, second upper panel) were maintained around 7% during the study. Abbreviations: ARB, angiotensin II receptor blocker; ARC, active renin concentration; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; MRA, mineralocorticoid receptor antagonist; PAC, plasma aldosterone concentration.
case_images: luac021f1.jpg
case_images: PMC10578373_01_luac021f1.jpg
case_images: luac021-F1
case_images: Urinalysis demonstrated proteinuria; however, no occult blood was observed (Fig. 1).
case_images: Computed tomography examination. No definite adrenal nodule was found in the bilateral adrenal glands. (A) Right adrenal gland. (B) Left adrenal gland. (C) Visceral adipose tissue accumulation was noted compared with the subcutaneous adipose tissue. High accumulation of visceral fat (145.4 cm2) and a visceral/subcutaneous adipose tissue ratio of 0.53 (reference range: <0.4) were observed. (D) Thinned bilateral cortexes of kidneys are presented.
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case_images: PMC10578373_01_luac021f2.jpg
case_images: luac021-F2
case_images: However, no definitive nodule was found in the adrenal glands (Fig. 2A and 2B). Visceral adipose accumulation was observed with a high visceral fat area and visceral/subcutaneous adipose tissue ratio (Fig. 2C).