Aldosterone/Renin in serum/plasma

Indications

• screening test for primary hyperaldosteronism
  • sustained BP >150/100 mm Hg on 3 separate occasions
  • hypertension (BP >140/90 mm Hg) resistant to 3 conventional antihypertensives (one of which is a diuretic)
  • controlled BP on >=4 antihypertensives
  • hypertension associated with spontaneous or diuretic-induced hypokalemia
  • hypertension & an adrenal incidentaloma
  • hypertension & sleep apnea
  • hypertension with a family history of either early-onset hypertension or cerebrovascular accident before age 40 years
  • hypertension in the setting of a first-degree relative with primary aldosteronism

Test interactions

• increases (false positives for primary hyperaldosteronism)
  • alpha-adrenergic receptor agonists
  • beta-adrenergic receptor antagonists
  • direct renin inhibitors
  • NSAIDs
• decreases (false negatives for primary hyperaldosteronism)
  • ACE inhibitors
  • dihydropyridine calcium channel blocker
  • diuretic
  • mineralocorticoid receptor antagonists
    • spironolactone, eplerenone
  • serotonin reuptake inhibitors

Clinical significance

• initial screening for primary hyperaldosteronism consists of midmorning ambulatory plasma renin + plasma aldosterone in a normovolemic, normokalemic patient
  • screening positive if plasma aldosterone > 15 ng/dL, or
  • plasma aldosterone/renin activity ratio

ratio	aldosterone	renin -> angiotensin-1
> 23	ng/dL	ng/mL/hr (positive)
> 23	ng/dL	ng/mL/hr sensitivity of 97%, specificity of 94%
> 67	ng/dL	ng/mL/hr sensitivity of 100%

* sensitivity for primary aldosteronism ranges from 10% to 100%

* specificity ranges from 70% to 100%

More general terms

• analyte ratio

Additional terms

• aldosterone (Electrocortin, Aldocortin)
• angiotensin-1/renin activity in plasma
• renin; angiotensinogenase (REN)

Components

• aldosterone in serum/plasma
• renin in plasma