Aldosterone/Renin ratio Aldosterone/ Direct renin
Serum
- A0616
Rs 6000
- Why Get Tested?
To determine if your aldosterone and renin levels are abnormal, to help diagnose a hormonal (endocrine) disorder such as primary aldosteronism (PA, Conn syndrome) - When To Get Tested?
When you develop symptoms or signs associated with increased aldosterone production, such as elevated blood pressure, muscle weakness, and low potassium, or low aldosterone production, such as low blood pressure, high potassium, and low sodium - Sample Type:SERUM (SST or Plain)
- Fasting :AS PER DOCTOR
- Report Delivery:4rd day 6pm
- Components:1 Observations
Tests Detail
| Observations Included |
| The Test marked with (*) are in our NABL Scope. |
Sample Report
- Also Known As:
Aldosterone and Plasma Renin Activity PRA - Formal Name:
Aldosterone, Serum; Aldosterone, Urine; Renin - Sample Instructions:
A blood sample drawn from a vein in your arm or a 24-hour urine sample; sometimes at specialized medical centers, blood from the kidney (renal) or adrenal veins is also collected. - Test Preparation Needed?
For a blood aldosterone and renin measurement, the healthcare practitioner may ask you to be upright or lying down (e.g., for 15-30 minutes) prior to drawing blood. You may also be instructed to avoid certain foods, beverages, or medications before the test. Follow any instructions you are given. - What Is Being Tested?
Aldosterone is a hormone that plays an important role in maintaining normal sodium and potassium concentrations in blood and in controlling blood volume and blood pressure. Renin is an enzyme that controls aldosterone production. These tests measure the levels of aldosterone and renin in the blood and/or the level of aldosterone in urine. Aldosterone is produced by the adrenal glands located at the top of each kidney, in their outer portion (called the adrenal cortex). Aldosterone stimulates the retention of sodium (salt) and the elimination of potassium by the kidneys. Renin is produced by the kidneys and controls the activation of the hormone angiotensin, which stimulates the adrenal glands to produce aldosterone. The kidneys release renin when there is a drop in blood pressure or a decrease in sodium chloride concentration in the tubules in the kidney. Renin cleaves the blood protein angiotensinogen to form angiotensin I, which is then converted by a second enzyme to angiotensin II. Angiotensin II causes blood vessels to constrict, and it stimulates aldosterone production. Overall, this raises blood pressure and keeps sodium and potassium at normal levels. A variety of conditions can lead to aldosterone overproduction (hyperaldosteronism, usually just called aldosteronism) or underproduction (hypoaldosteronism). Since renin and aldosterone are so closely related, both substances are often tested together to identify the cause of an abnormal aldosterone. How is the sample collected for testing? A blood sample is drawn by needle from a vein in the arm to measure blood aldosterone and/or renin. Some healthcare practitioners prefer 24-hour urine collection for aldosterone since blood aldosterone levels vary throughout the day and are affected by position. In some cases, blood is collected from the renal (for renin) or adrenal (for aldosterone) veins by insertion of a catheter; this is done in the hospital at major medical centers by a specially trained radiologis - How Is It Used?
Aldosterone and renin tests are used to evaluate whether the adrenal glands are producing appropriate amounts of aldosterone and to distinguish between the potential causes of excess or deficiency. Aldosterone may be measured in the blood or in a 24-hour urine sample, which measures the amount of aldosterone removed in the urine in a day. Renin is always measured in blood. These tests are most useful in testing for primary aldosteronism, also known as Conn syndrome, which causes high blood pressure. If the test is positive, aldosterone production may be further evaluated with stimulation and suppression testing. Both aldosterone and renin levels are highest in the morning and vary throughout the day. They are affected by the body's position, by stress, and by a variety of prescribed medications. - When Is It Ordered
A blood aldosterone test and a renin test are usually ordered together when someone has high blood pressure, especially if the person also has low potassium. Even if potassium is normal, testing may be done if typical medications do not control the high blood pressure or if hypertension develops at an early age. Primary aldosteronism is a potentially curable form of hypertension, so it is important to detect and treat it properly. Aldosterone levels are occasionally ordered, along with other tests, when a healthcare practitioner suspects that someone has adrenal insufficiency or Addison disease. One of those tests, the aldosterone stimulation test, also called ACTH stimulation, tests aldosterone and cortisol to determine if someone has Addison disease, low pituitary function, or a pituitary tumor. A normal result is a cortisol increase and an increase in aldosterone after stimulation by ACTH. - What Does The Test Result Mean?
The table below indicates the changes in renin, aldosterone, and cortisol that occur with different disorders. Disease Aldosterone Cortisol Renin Primary aldosteronism (Conn syndrome) High Normal Low Secondary aldosteronism High Normal High Adrenal insufficiency (Addison disease) Low Low High Cushing syndrome Low High Low Primary aldosteronism (Conn syndrome) is caused by the overproduction of aldosterone by the adrenal glands, usually by a benign tumor of one of the glands. The high aldosterone level increases reabsorption of sodium (salt) and loss of potassium by the kidneys, often resulting in an electrolyte imbalance. Signs and symptoms include high blood pressure, headache, and muscle weakness, especially if potassium levels are very low. Lower than normal blood potassium (hypokalemia) in someone with hypertension suggests the need to look for aldosteronism. Sometimes, to determine whether only one or both adrenal glands are affected, blood may be taken from both of the adrenal veins and testing is done to determine whether there is a difference in the amount of aldosterone (and sometimes cortisol) produced by each of the adrenal glands. Secondary aldosteronism, which is more common than primary aldosteronism, is caused by anything that leads to excess aldosterone, other than a disorder of the adrenal glands. It could be caused by any condition that decreases blood flow to the kidneys, decreases blood pressure, or lowers sodium levels. Secondary aldosteronism may be seen with congestive heart failure, cirrhosis of the liver, kidney disease, and toxemia of pregnancy (pre-eclampsia). It is also common in dehydration. In these conditions, the cause of aldosteronism is usually obvious. The most important cause of secondary aldosteronism is narrowing of the blood vessels that supply the kidney, termed renal artery stenosis. This causes high blood pressure due to high renin and aldosterone and may be cured by surgery or angioplasty. Sometimes, to see - Is There Anything Else I Should Known?
The amount of salt in your diet and medications, such as over-the-counter pain relievers of the non-steroid class, diuretics, beta blockers, steroids, angiotensin-converting enzyme (ACE) inhibitors, and oral contraceptives can affect the test results. Some of these drugs are used to treat high blood pressure. Stress, exercise, and pregnancy can also affect the test results. Your healthcare provider will tell you if you should change the amount of sodium (salt) you ingest in your diet, your use of diuretics or other medications, or your exercise routine before aldosterone testing. Licorice may mimic aldosterone properties and should be avoided for at least two weeks before the test because it can decrease aldosterone results. This refers only to the actual products of the licorice plant (hard licorice); most soft licorice and other forms of licorice sold in North America do not actually contain licorice. Check the package label if you are uncertain, or bring a package with you to ask the healthcare practitioner. Aldosterone levels become very low with severe illness, so testing should not be done at times when someone is very ill. If my posture is important in the outcome of the results, how can I control it? You may be asked to arrive well before your testing time so you can remain in a lying or upright position long enough to establish that as your baseline testing position. What is an aldosterone/renin ratio (ARR?) An aldosterone/renin ratio (ARR) is a screening test to detect primary aldosteronism in high-risk, hypertensive individuals. To determine the ratio, blood levels of aldosterone and renin are measured and a calculation is done by dividing the aldosterone result by the renin result. The ARR is considered the most reliable screening for primary aldosteronism, though it is not straightforward to interpret. Anything that could interfere with the test, such as medications, posture, sodium intake, and plasma potassium, needs to be taken into account before
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