Kobayashi H, Abe M, Nakamura Y, et al. - In a retrospective cohort from the multicenter Japan Primary Aldosteronism Study, researchers examined the link between initial estimated glomerular filtration rate (eGFR) fall after primary aldosteronism-specific treatment and long-term eGFR slope. Participants were patients with primary aldosteronism, who were assigned to adrenalectomy (n = 202) and MR (mineralocorticoid receptor) antagonist (n = 303) groups on the basis of their treatment history. In both groups, the factors that were found to be independent predictors of a large initial eGFR decline were increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels. They found that the smaller the acute decline in eGFR by the start of MR antagonists, the greater was the rate of long-term eGFR reduction. Overall, primary aldosteronism-specific treatment-induced acute fall in eGFR occasionally represents a clinical concern, nonetheless, its favorable implications with respect to long-term renal outcomes were highlighted in this study.