Pathology Handbook

Aldosterone and Renin

Clinical Indications

Investigation of primary hyperaldosteronism.

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Request on ICE

Availability

Analysed by referral laboratory if specific criteria met

Specific Criteria

Requested by Consultant Renal Physicians or if agreed with Consultant Biochemist. Investigation will normally only be undertaken if patient has persistent hypokalaemia (< 3.5 mmol/l) and inappropriate urinary potassium loss (> 35 mmol/24hr).

Patient Preparation

Drugs that interfere with the aldosterone / renin must be discontinued prior to testing, please see the table below for minimum periods of withdrawl:

Minimum Period Of Withdrawal Drug Type Examples Of Names Mechanism Of Action
6 Weeks Spironolactone Spironolactone, Co-flumactone, Aldactone, Lasilactone, Spiroctan Causes formation of 'Spironolactone bodies' in adrenal cells. 
Oestrogen Preparations Increase Aldosterone Production.
2 Weeks Diuretic See accompanying list Increase PRA and therefore also increase plasma aldosterone.
Prostoglandin Synthetase Inhibitors Indomethacin Decrease PRA and therefore also decrease plasma aldosterone levels.
Sedative Antihistamines Cyproheptadine Prevent formation of angiotensin II and thereby decrease aldosterone levels - while increasing PRA at the same time.
ACE Inhibitors See Accompanying List Prevent formation of angiotensin II and thereby decrease aldosterone levels - while increasing PRA at the same time.
Angiotensin II Receptor Antagonists See Accompanying List Same of ACE inhibitors i.e. decrease aldosterone levels and increase renin secretion.
1 Week Vasodilators Hydralazine, Diazoxide Increase PRA and therefore also increase plasma aldosterone.
B Blockers in large doses only In large doses may decrease PRA and therfore also decrease plasma aldosterone.
Calcium channel blockers See accompanying list Decrease synthesis of aldosterone such that plasma levels may be up to the drug. May increase PRA - but only to a small degree.

Sympatho-mimetics

Adrenergic inhibitors

Dobutamine, Isoprenaline, Adrenalin, Ismelin, Bendogen, Debrisoquine

0 Weeks

i.e. Drugs which may safely be continued/substituted for other antihypertensives during investigation of renin/aldosterone

B Blockers in usual doses

Alpha blockers

Doxazosin - Cardura

Prazosin - Hypovase

Terazosin - Hyprin

Indoramin - Baratole

Phenoxybenzamine - Dibenyline

Drug Proprietary Name
B Blockers
Acebutolol Sectral, Secadrex
Atenalol Tenormin, Co-tenidone, Kalten, Tenben, Tenoret, Tenoretic, Beta-Adalat, Tenif
Betaxolol Kerlone
Bisoprolol Fumarale Emcor, Monocor, Monozide, Cardicor
Carvedilol Eucardic
Celiprolol Celectol
Esmolol Brevibloc
Labetalol Trandate, Labetalol Hydrochloride
Metroprolol Betaloc, Lopresor, Co-Betaloc
Nadolol Corgard, Corgaretic
Nebivolol Nebilet
Oxyprenolol Oxprenolol, Trasicor, Trasidrex
Pindolol Visken, Viskaldix
Propanolol Inderal, Inderex, Inderetic
Sotalol Sotacor, Beta Cardone
Timolol Betim, Moducren, Prestim
Diuretics
Bendrofluazide
Chlorthalidone Hygroton
Cyclopenthiazide Navidrex
Hydrochlorothiazide Hydrosaluric
Indapamide Natrilix
Metolazone Metenix
Polythiazide Nephril
Xipamide Diurexan
Frusemide Lasix, Furosemide
Bumetanide Burinex
Torasemide Torem
Amiloride Coamilozide, Navispare, Co-amilofruse, Burinex A, Co-triamterzide, Dyazide, Dytide, Kalspare, Frusene
Triamterene Dytac
ACE Inhibitors
Captopril Capoten, Capozide, Co-zidocapt 
Cilazapril Vascace
Enalopril Innovace, Innozide, Enalopril maleate
Fosinopril Staril
Imidapril Hydrochloride Tanatril
Lisinopril Carace, Zestril, Zestoretic
Moexipril Perdix
Perindopril Coversyl
Quinopril Accupo, Accuretic
Ramipril Tritace, Triapin
Trandolapril Gopten, Odrik, Tarka
Calcium Channel Blockers
Verapamil Cordilox, Securon, Verapress, Vertab, Securon, Univer
Nifedipine Adalat, Adipine, Cardilate, Coracten, Coroday, Fortipine, Hypolar, Nifedotard, Nifelease, Nifensar, Nifopress, Nifedipress, Slofedipine, Tensipine
Nicardipine Cardene
Amlodipine Istin
Felodipine Plendil
Isradipine Prescal
Lacidipine Motens
Nimodipine Nimotop
Diltiazem Adizem, Tildiem, Angitil, Dilzem, Viazem, Zemtard, Calctard, Dilcardia, Slozem
Lercanidinipine Hydrochloride Zandip
Nisoldipine Syscor
Angiotensin II Receptor Antagonists
Candesartan Cilexetil,  Amias
Eprosartan Teveten
Irbesartan Aprovel, CoAprovel
Losartan Cozaar
Telmisartan Micardis
Valsartan Diovan

The use of the renin:angiotensin ratio has largely replaced the need for patients to have been recumbent before the test.

Turnaround Time

1 month

Specimen

Lithium heparin plasma (Two samples required) for Renin & Aldosterone levels, plus a SST serum sample for U&E and Bicarbonate levels

Volume

2 ml plasma (aldosterone), 5ml plasm (renin), 2ml serum (U&E, Bicarb)

Container

Vacutainer green top

Vacutainer green top

Vacutainer gold top

Collection

Samples must be transported to laboratory immediately

Lab Handling

Sent to referral laboratory (Charing Cross)

Causes for Rejection

Unlabelled or incorrectly labelled sample; not meeting specific criteria for analysis; delay in sample reaching laboratory or in wrong sample container

Reference Range

See laboratory report for ranges and interpretation