Activity Assays and Immunoassays for Plasma Renin and Prorenin: Information Provided and Precautions Necessary for Accurate Measurement

Campbell, Duncan J.; Nussberger, Juerg; Stowasser, Michael; Danser, A.H. Jan; Morganti, Alberto; Frandsen, Erik; Ménard, Joël

doi:10.1373/clinchem.2008.118000

Cited by 163 publications

(133 citation statements)

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“…Some studies in healthy volunteers reported a close correlation between PRA values and plasma renin concentrations, as determined by immunoassay. 29 However, this correlation was not as close for low PRA and plasma renin concentrations, and in patients with different angiotensinogen concentrations. 29 The pivotal role of aldosterone in the pathophysiology of EH is now well documented.…”

Section: Discussionmentioning

confidence: 98%

“…29 However, this correlation was not as close for low PRA and plasma renin concentrations, and in patients with different angiotensinogen concentrations. 29 The pivotal role of aldosterone in the pathophysiology of EH is now well documented. [30][31][32] Although 15% of patients with hypertension exhibit alterations in aldosterone regulation, they do not meet the criteria for PA. Suppression of renin is thought to be the earliest feature of PA. 33 The use of A PL /PRA ratio in populations with high prevalence of low-renin hypertension may lead to a high number of false-positive results.…”

Section: Discussionmentioning

confidence: 98%

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Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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“…Additionally, in recent years automated methodology for PRC measurement has been developed. The disadvantages include greater prorenin cryoactivation effects and less sensitivity when measuring low renin concentrations (35). Since PRC and ALD/renin ratio have been proposed for PA screening (4,5), we determined PRC in a subgroup of randomly selected controls and hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Reyna¹,

Gómez

Lupi

et al. 2015

Arch. Endocrinol. Metab.

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Objectives: Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone. Its prevalence has increased since the use of the aldosterone (ALD)/plasma renin activity (PRA) ratio (ARR). The objective of this study is to determine ARR and ARC (ALD/plasma renin concentration ratio) cut-off values (COV) and their diagnostic concordance (DC%) in the screening for PA in an Argentinian population. Design: multicenter prospective study. Subjects and methods: We studied 353 subjects (104 controls and 249 hypertensive patients). Serum aldosterone, PRA and ARR were determined. In 220 randomly selected subjects, 160 hypertensive patients and 60 controls, plasma renin concentration (PRC) was simultaneously measured and ARC was determined. Results: According to the 95 th percentile of controls, we determined a COV of 36 for ARR and 2.39 for ARC, with ALD ≥ 15 ng/dL. In 31/249 hypertensive patients, ARR was ≥ 36. PA diagnosis was established in 8/31 patients (23/31 patients did not complete confirmatory tests). DC% between ARR and ARC was calculated. A significant correlation between ARR and ARC (r = 0.742; p < 0.0001) was found only with PRA > 0.3 ng/mL/h and PRC > 5 pg/mL. DC% for ARR and ARC above or below 36 and 2.39 was 79.1%, respectively. Conclusion: This first Argentinian multicenter study determined a COV of 36 for ARR and 2.39 for ARC. Applying an ARR ≥ 36 in the hypertensive group, we confirmed PA in a higher percentage of patients than the previously reported one in our population. As for ARC, further studies are needed for its clinical application, since DC% is acceptable only for medium range renin values. Arch Endocrinol Metab. 2015;59(5):441-7

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“…In the present study, circulating renin levels were measured using the PRA assay, which is one of the most commonly used methods for measuring plasma renin. 22 In the absence of renin inhibitors or other RAAS-related antagonists, activity assays provide information regarding the quantity of enzymatically active renin in the plasma. 22 …”

Section: Clinical Measurementsmentioning

confidence: 99%

“…22 In the absence of renin inhibitors or other RAAS-related antagonists, activity assays provide information regarding the quantity of enzymatically active renin in the plasma. 22 …”

Section: Clinical Measurementsmentioning

confidence: 99%

The obesity-related polymorphism PCSK1 rs6235 is associated with essential hypertension in the Han Chinese population

Ling

et al. 2012

Hypertens Res

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Proprotein convertase subtilisin/kexin-type 1 (PCSK1) is a prohormone convertase that has an important role in prohormone maturation including the process of prorenin to renin. We studied the association of the PCSK1 single-nucleotide polymorphism (SNP) rs6235 (encoding an S690T substitution) with essential hypertension (EH), obesity and related traits in the Han Chinese population. The rs6235 SNP in the PCSK1 gene was investigated using a case-control study design, with 1034 hypertension cases and 1112 normotensive controls. In this study, the rs6235 SNP was significantly associated with hypertension (OR ¼ 1.26, 95% CI (1.10-1.46), P ¼ 0.001); the odds ratios of GC vs GG and CC vs GG were 1.30 (95% CI (1.06-1.58), P ¼ 0.010) and 1.55 (95% CI (1.12-2.13), P ¼ 0.007), respectively. In the controls, the C-allele was associated with increased systolic (P ¼ 0.010) and diastolic (P ¼ 0.010) blood pressure levels. In all of the EH patients and EH patients without a history of renin-angiotensin-aldosterone (RAA) system-related antagonists, the C-allele was associated with increased plasma renin activity (P ¼ 0.00004 and 0.002, respectively) and aldosterone levels (P ¼ 0.018 and 0.005, respectively). The C-allele was also associated with increased body mass index (BMI) (P ¼ 0.010) in the normotensive controls. In conclusion, the PCSK1 SNP rs6235 was associated with EH and blood pressure in the Han Chinese population, and this association may be mediated by the SNP's effect on RAA levels. rs6235 was also associated with BMI in this population.

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Activity Assays and Immunoassays for Plasma Renin and Prorenin: Information Provided and Precautions Necessary for Accurate Measurement

Cited by 163 publications

References 68 publications

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

The obesity-related polymorphism PCSK1 rs6235 is associated with essential hypertension in the Han Chinese population

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