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DOI: 10.1055/a-0672-0836
Aldosterone to Renin Ratio as Screening Tool in Primary Aldosteronism
Publikationsverlauf
received 15. Mai 2018
revised 18. Juli 2018
accepted 08. August 2018
Publikationsdatum:
30. August 2018 (online)
Abstract
Primary aldosteronism (PA) is a severe and often underdiagnosed form of secondary hypertension. Determining the aldosterone to renin ratio (ARR) in hypertensive patients has been shown to be a valuable screening test for identification of patients suffering from PA. Since the introduction of a more widespread ARR screening the number of PA patients significantly increased worldwide. Interpretation of ARR might be challenging: Several factors from posture to interfering drugs affect the ARR and need to be taken into account when collecting samples. In addition, the wide variety of available assay methods and lack of well-established cut-offs present a challenge to the clinician. This review discusses the usefulness and possible difficulties of ARR screening.
* Katharina Schilbach and Riia Karoliina Junnila contributed equally to this manuscript.
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References
- 1 Rossi GP, Bernini G, Caliumi C. et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
- 2 Funder JW, Carey RM, Mantero F. et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
- 3 Born-Frontsberg E, Reincke M, Rump LC. et al. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: Results of the German Conn's Registry. J Clin Endocrinol Metab 2009; 94: 1125-1130
- 4 Mulatero P, Monticone S, Bertello C. et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98: 4826-4833
- 5 Savard S, Amar L, Plouin PF. et al. Cardiovascular complications associated with primary aldosteronism: A controlled cross-sectional study. Hypertension 2013; 62: 331-336
- 6 Bertacchini F, Paini A, Salvetti M. et al. 9b.08: Cardiac and vascular damage in patients with primary aldosteronism and essential. Hypertension. J Hypertens 2015; 33 (Suppl. 01) e122
- 7 Hollenberg NK. Aldosterone in the development and progression of renal injury. Kidney Int 2004; 66: 1-9
- 8 Aronova A, Fahey III TJ, Zarnegar R. Management of hypertension in primary aldosteronism. World J Cardiol 2014; 6: 227-233
- 9 Hiramatsu K, Yamada T, Yukimura Y. et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med 1981; 141: 1589-1593
- 10 Mulatero P, Stowasser M, Loh KC. et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1045-1050
- 11 Tomaschitz A, Pilz S, Ritz E. et al. Aldosterone and arterial hypertension. Nat Rev Endocrinol 2010; 6: 83-93
- 12 Jiang SB, Guo XD, Wang HB. et al. A retrospective study of laparoscopic unilateral adrenalectomy for primary hyperaldosteronism caused by unilateral adrenal hyperplasia. Int Urol Nephrol 2014; 46: 1283-1288
- 13 Griffin AC, Kelz R, LiVolsi VA. Aldosterone-secreting adrenal cortical carcinoma. A case report and review of the literature. Endocr Pathol 2014; 25: 344-349
- 14 Molina-Ayala M, Ramirez-Renteria C, Manguilar-Leon A. et al. A rare presentation of primary hyperparathyroidism with concurrent aldosterone-producing adrenal carcinoma. Case Rep Endocrinol 2015; 2015: 910984
- 15 Monticone S, Buffolo F, Tetti M. et al. GENETICS IN ENDOCRINOLOGY: The expanding genetic horizon of primary aldosteronism. Eur J Endocrinol 2018; 178: R101-R111
- 16 Mourtzinis G, Ebrahimi A, Gustafsson H. et al. Aldosterone to renin ratio as a screening instrument for primary aldosteronism in a middle-aged population with atrial fibrillation. Horm Metab Res 2017; 49: 831-837
- 17 Luo Q, Li NF, Yao XG. et al. Potential effects of age on screening for primary aldosteronism. J Hum Hypertens 2016; 30: 53-61
- 18 Bolignano D, Mattace-Raso F, Sijbrands EJ. et al. The aging kidney revisited: A systematic review. Ageing Res Rev 2014; 14: 65-80
- 19 Hannemann A, Friedrich N, Ludemann J. et al. Reference intervals for aldosterone, renin, and the aldosterone-to-renin ratio in the population-based Study of Health in Pomerania (SHIP-1). Horm Metab Res 2010; 42: 392-399
- 20 Fischer M, Baessler A, Schunkert H. Renin angiotensin system and gender differences in the cardiovascular system. Cardiovasc Res 2002; 53: 672-677
- 21 Deng L, Xiong Z, Li H. et al. Analytical validation and investigation on reference intervals of aldosterone and renin in Chinese Han population by using fully automated chemiluminescence immunoassays. Clin Biochem 2018; DOI: 10.1016/j.clinbiochem.2018.04.016:.
- 22 Pizzolo F, Raffaelli R, Memmo A. et al. Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism. J Hypertens 2010; 28: 135-142
- 23 Ahmed AH, Gordon RD, Ward G. et al. Effect of combined hormonal replacement therapy on the aldosterone/renin ratio in postmenopausal women. J Clin Endocrinol Metab 2017; 102: 2329-2334
- 24 Szmuilowicz ED, Adler GK, Williams JS. et al. Relationship between aldosterone and progesterone in the human menstrual cycle. J Clin Endocrinol Metab 2006; 91: 3981-3987
- 25 Fommei E, Ghione S, Ripoli A. et al. The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women. J Hum Hypertens 2009; 23: 130-135
- 26 Ahmed AH, Gordon RD, Taylor PJ. et al. Are women more at risk of false-positive primary aldosteronism screening and unnecessary suppression testing than men?. J Clin Endocrinol Metab 2011; 96: E340-E346
- 27 Tiu SC, Choi CH, Shek CC. et al. The use of aldosterone-renin ratio as a diagnostic test for primary hyperaldosteronism and its test characteristics under different conditions of blood sampling. J Clin Endocrinol Metab 2005; 90: 72-78
- 28 Brandenberger G, Follenius M, Muzet A. et al. Ultradian oscillations in plasma renin activity: Their relationships to meals and sleep stages. J Clin Endocrinol Metab 1985; 61: 280-284
- 29 Kerstens MN, Kobold AC, Volmer M. et al. Reference values for aldosterone-renin ratios in normotensive individuals and effect of changes in dietary sodium consumption. Clin Chem 2011; 57: 1607-1611
- 30 Koch M, Aker S, Haastert B. et al. Clinical relevance of dietary salt intake on aldosterone and the aldosterone-to-renin ratio as screening parameters for primary aldosteronism. Clin Nephrol 2010; 74: 182-189
- 31 Stowasser M, Ahmed AH, Pimenta E. et al. Factors affecting the aldosterone/renin ratio. Horm Metab Res 2012; 44: 170-176
- 32 Fischer E, Beuschlein F, Bidlingmaier M. et al. Commentary on the endocrine society practice guidelines: Consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord 2011; 12: 43-48
- 33 Duprez DA, De Sutter JH, De Buyzere ML. et al. Renin-angiotensin-aldosterone system, RR interval, and blood pressure variability during postural changes in borderline arterial hypertension. Am J Hypertens 1995; 8: 683-688
- 34 Lamarre-Cliche M, de Champlain J, Lacourciere Y. et al. Effects of circadian rhythms, posture, and medication on renin-aldosterone interrelations in essential hypertensives. Am J Hypertens 2005; 18: 56-64
- 35 Pilz S, Kienreich K, Gaksch M. et al. Aldosterone to active Renin ratio as screening test for primary aldosteronism: Reproducibility and influence of orthostasis and salt loading. Horm Metab Res 2014; 46: 427-432
- 36 Epstein M. Aldosterone and the hypertensive kidney: Its emerging role as a mediator of progressive renal dysfunction: A paradigm shift. J Hypertens 2001; 19: 829-842
- 37 Brewster UC, Perazella MA. The renin-angiotensin-aldosterone system and the kidney: Effects on kidney disease. Am J Med 2004; 116: 263-272
- 38 Lv LL, Liu BC. Role of non-classical renin-angiotensin system axis in renal fibrosis. Front Physiol 2015; 6: 117
- 39 Barigou M, Ah-Kang F, Orloff E. et al. Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension. Ann Cardiol Angeiol (Paris) 2015; 64: 169-174
- 40 Catena C, Colussi G, Nadalini E. et al. Relationships of plasma renin levels with renal function in patients with primary aldosteronism. Clin J Am Soc Nephrol 2007; 2: 722-731
- 41 Ribstein J, Du Cailar G, Fesler P. et al. Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 2005; 16: 1320-1325
- 42 Oelkers W, Diederich S, Bahr V. Primary hyperaldosteronism without suppressed renin due to secondary hypertensive kidney damage. J Clin Endocrinol Metab 2000; 85: 3266-3270
- 43 Markou A, Sertedaki A, Kaltsas G. et al. Stress-induced aldosterone hyper-secretion in a substantial subset of patients with essential hypertension. J Clin Endocrinol Metab 2015; 100: 2857-2864
- 44 Seely EW, Conlin PR, Brent GA. et al. Adrenocorticotropin stimulation of aldosterone: Prolonged continuous versus pulsatile infusion. J Clin Endocrinol Metab 1989; 69: 1028-1032
- 45 Arvat E, Di Vito L, Lanfranco F. et al. Stimulatory effect of adrenocorticotropin on cortisol, aldosterone, and dehydroepiandrosterone secretion in normal humans: Dose-response study. J Clin Endocrinol Metab 2000; 85: 3141-3146
- 46 Whitworth JA, Butty J, Saines D. et al. The effects of ACTH on the renin-aldosterone system in normotensive man. Clin Exp Hypertens A 1985; 7: 1361-1376
- 47 Ahmed AH, Gordon RD, Ward G. et al. Effect of Moxonidine on the Aldosterone/Renin Ratio in Healthy Male Volunteers. J Clin Endocrinol Metab 2017; 102: 2039-2043
- 48 Seifarth C, Trenkel S, Schobel H. et al. Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clin Endocrinol (Oxf) 2002; 57: 457-465
- 49 Mulatero P, Rabbia F, Milan A. et al. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension 2002; 40: 897-902
- 50 Kondo T, Goto R, Sonoda K. et al. Plasma renin activity and aldosterone concentration are not altered by the novel calcium channel antagonist, azelnidipine, in hypertensive patients. Intern Med 2010; 49: 637-643
- 51 Jansen PM, van den Born BJ, Frenkel WJ. et al. Test characteristics of the aldosterone-to-renin ratio as a screening test for primary aldosteronism. J Hypertens 2014; 32: 115-126
- 52 Ahmed AH, Gordon RD, Taylor P. et al. Effect of atenolol on aldosterone/renin ratio calculated by both plasma Renin activity and direct Renin concentration in healthy male volunteers. J Clin Endocrinol Metab 2010; 95: 3201-3206
- 53 Griffin TP, Browne GA, Wall D. et al. A cross-sectional study of the effects of beta-blocker therapy on the interpretation of the aldosterone/renin ratio: Can dosing regimen predict effect?. J Hypertens 2016; 34: 307-315
- 54 Campbell DJ. Aliskiren therapy will have minimal effect on intracellular renin of renin-producing cells. Hypertension 2009; 53: e17 author reply e18
- 55 Campbell DJ, Nussberger J, Stowasser M. et al. Activity assays and immunoassays for plasma Renin and prorenin: Information provided and precautions necessary for accurate measurement. Clin Chem 2009; 55: 867-877
- 56 Snoep JD, Hovens MM, Pasha SM. et al. Time-dependent effects of low-dose aspirin on plasma renin activity, aldosterone, cortisol, and catecholamines. Hypertension 2009; 54: 1136-1142
- 57 Ahmed AH, Calvird M, Gordon RD. et al. Effects of two selective serotonin reuptake inhibitor antidepressants, sertraline and escitalopram, on aldosterone/renin ratio in normotensive depressed male patients. J Clin Endocrinol Metab 2011; 96: 1039-1045
- 58 Pizzolo F, Pavan C, Corrocher R. et al. Laboratory diagnosis of primary aldosteronism, and drospirenone-ethinylestradiol therapy. Am J Hypertens 2007; 20: 1334-1337
- 59 Locsei Z, Horvath D, Racz K. et al. Progestin-dependent effect of oral contraceptives on plasma aldosterone/renin ratio. Clin Biochem 2012; 45: 1516-1518
- 60 Ahmed AH, Gordon RD, Taylor PJ. et al. Effect of contraceptives on aldosterone/renin ratio may vary according to the components of contraceptive, renin assay method, and possibly route of administration. J Clin Endocrinol Metab 2011; 96: 1797-1804
- 61 Quinkler M, Stewart PM. Hypertension and the cortisol-cortisone shuttle. J Clin Endocrinol Metab 2003; 88: 2384-2392
- 62 Epstein MT, Espiner EA, Donald RA. et al. Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J 1977; 1: 488-490
- 63 Fischer E, Reuschl S, Quinkler M. et al. Assay characteristics influence the aldosterone to renin ratio as a screening tool for primary aldosteronism: Results of the German Conn's registry. Horm Metab Res 2013; 45: 526-531
- 64 Schirpenbach C, Seiler L, Maser-Gluth C. et al. Automated chemiluminescence-immunoassay for aldosterone during dynamic testing: Comparison to radioimmunoassays with and without extraction steps. Clin Chem 2006; 52: 1749-1755
- 65 Manolopoulou J, Fischer E, Dietz A. et al. Clinical validation for the aldosterone-to-renin ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays. J Hypertens 2015; 33: 2500-2511
- 66 Burrello J, Buffolo F, Monticone S. et al. 9b.06: Comparison between Aldosterone and Renin Measurement by Chemiluminescent Immunoassay and Radioimmunoassay for the Diagnosis of Primary Aldosteronism. J Hypertens 2015; 33 (Suppl. 01) e121
- 67 Juutilainen A, Savolainen K, Romppanen J. et al. Combination of LC-MS/MS aldosterone and automated direct renin in screening for primary aldosteronism. Clin Chim Acta 2014; 433: 209-215
- 68 Van Der Gugten JG, Dubland J, Liu HF. et al. Determination of serum aldosterone by liquid chromatography and tandem mass spectrometry: A liquid-liquid extraction method for the ABSCIEX API-5000 mass spectrometry system. J Clin Pathol 2012; 65: 457-462
- 69 Taylor PJ, Cooper DP, Gordon RD. et al. Measurement of aldosterone in human plasma by semiautomated HPLC-tandem mass spectrometry. Clin Chem 2009; 55: 1155-1162
- 70 Turpeinen U, Hamalainen E, Stenman UH. Determination of aldosterone in serum by liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 862: 113-118
- 71 Taylor PJ, Gordon RD, Stowasser M. Calibrators for measuring aldosterone by liquid chromatography-tandem mass spectrometry. Clin Chim Acta 2012; 413: 346-347
- 72 Morganti A. European study group for the validation of DiaSorin LDRA. A comparative study on inter and intralaboratory reproducibility of renin measurement with a conventional enzymatic method and a new chemiluminescent assay of immunoreactive renin. J Hypertens 2010; 28: 1307-1312
- 73 Rossi GP, Barisa M, Belfiore A. et al. The aldosterone-renin ratio based on the plasma renin activity and the direct renin assay for diagnosing aldosterone-producing adenoma. J Hypertens 2010; 28: 1892-1899
- 74 Glinicki P, Jeske W, Bednarek-Papierska L. et al. The ratios of aldosterone/plasma renin activity (ARR) versus aldosterone/direct renin concentration (ADRR). J Renin Angiotensin Aldosterone Syst 2015; 16: 1298-1305
- 75 Lonati C, Bassani N, Gritti A. et al. Measurement of plasma renin concentration instead of plasma renin activity decreases the positive aldosterone-to-renin ratio tests in treated patients with essential hypertension. J Hypertens 2014; 32: 627-634
- 76 Unger N, Lopez Schmidt I, Pitt C. et al. Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Eur J Endocrinol 2004; 150: 517-523
- 77 Ducher M, Mounier-Vehier C, Baguet JP. et al. Aldosterone-to-renin ratio for diagnosing aldosterone-producing adenoma: A multicentre study. Arch Cardiovasc Dis 2012; 105: 623-630
- 78 Perschel FH, Schemer R, Seiler L. et al. Rapid screening test for primary hyperaldosteronism: Ratio of plasma aldosterone to renin concentration determined by fully automated chemiluminescence immunoassays. Clin Chem 2004; 50: 1650-1655
- 79 Phillips JL, Walther MM, Pezzullo JC. et al. Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. J Clin Endocrinol Metab 2000; 85: 4526-4533
- 80 Berge C, Courand PY, Harbaoui B. et al. Decreased plasma prorenin levels in primary aldosteronism: Potential diagnostic implications. J Hypertens 2015; 33: 118-125