Current laboratory requirements for adrenocorticotropic hormone and renin/aldosterone sample handling are unnecessarily restrictive

Chakera, Ali J.; McDonald, Timothy J.; Knight, Bridget; Vaidya, Bijay; Jones, Angus G.

doi:10.7861/clinmedicine.17-1-18

“…Chakera et al. [ 19 ] even observed significantly lower renin mass in EDTA plasma compared to serum in samples that were centrifuged immediately and frozen at –80 °C prior to analysis. Not all studies have observed this difference though, as de Bruin et al.…”

Section: Resultsmentioning

confidence: 99%

“…There is conflicting information regarding renin stability at room temperature in whole blood. Estimates range from less than 6 h [ 19 ] to greater than 72 h [ 20 ]. Due to the uncertainty concerning renin stability, it may be best to err on the side of caution and allow less time rather than more, particularly for renin activity assays.…”

Section: Resultsmentioning

confidence: 99%

Survey of renin and aldosterone testing practices by Ontario laboratories – Providing insight into best practices

Rutledge

¹

,

Johnston²,

Bailey

³

et al. 2021

Practical Laboratory Medicine

6

1

0

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Objectives Testing for renin and aldosterone in clinical laboratories is complicated by pre-analytical considerations such as the posture for blood collection and susceptibility to cryoactivation of renin. From an analytical perspective, there are both renin activity and renin mass or concentration assays available. There can also be variability in result reporting practices and the aldosterone-renin ratio (ARR) cut-off applied to screen for primary aldosteronism (PA). The Institute for Quality Management in Healthcare (IQMH) Centre for Proficiency Testing surveyed laboratories on their handling of renin and aldosterone testing to better understand current practices. Design and methods An online survey was prepared and sent to 134 Canadian laboratories enrolled in endocrinology proficiency testing with IQMH. Results One hundred twenty Ontario laboratories submitted responses. While only six (5%) laboratories perform testing for both renin and aldosterone, 108 (90%) collect and process specimens to be tested by reference laboratories. The survey revealed considerable variation in practices including the recommended state of patients prior to sample collection (for example, regarding medications or salt intake), the patient posture specifications for sample collection, the precautions taken against cryoactivation of renin, the choice of renin activity or mass assay, and the ARR cut-off used. The available literature on these factors was then reviewed. Conclusions Although there is no standardized procedure for specimen collection, analysis, or result reporting for renin or aldosterone testing, we have attempted to summarize the available literature to develop evidence-based recommendations. Where laboratory practice differs from peers and/or recommended protocols, laboratories should review their practices.

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“…Urinary creatinine concentration was reduced (compared to not frozen samples) in untreated samples stored for 12 months at −20 °C and −80 °C, with a mean (95% CI) percent change of −4.3% (−6.0 to −2.5) and −3.5% (−5.1 to −1.9) (p = 0.0001) respectively. However, this is not a clinically significant change (<10%) [[15], [16], [17]]. This is not true for alkalised samples stored at −20 °C, as the change in creatinine was much greater at −15.6% (−25.0 to −6.1) (p < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…We identified a small loss in urinary creatinine concentration in untreated samples after storage for 12 months at both −20 °C and −80 °C. This small difference is not clinically significant [[15], [16], [17]] and did not influence the ACR, it may reflect assay imprecision. Creatinine stability during prolonged frozen storage has been reported in other studies [5,12].…”

Section: Discussionmentioning

confidence: 99%

Stability of urinary albumin and creatinine after 12 months storage at −20 °C and −80 °C

Chapman

¹

,

Gooding

²

,

McDonald

³

et al. 2019

Practical Laboratory Medicine

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Background Increasing albumin to creatinine ratio (ACR) within the normal range is a risk factor for cardiovascular disease in the general population. Clinical and epidemiological studies often store urine samples for long durations prior to ACR assessment. The stability of ACR at the lowest urinary albumin concentrations during prolonged storage has not been previously studied because routine clinical assays can’t quantify very low concentrations of albumin. Aim To determine the stability of urinary albumin and creatinine over 12 months in samples stored at −20 °C and −80 °C using an assay which enables assessment of previously undetectable levels of albumin and to investigate if additives can be used to prevent urinary albumin degradation. Method ACR was measured in 30 urine samples from healthy subjects on the day of collection. Each sample was divided into 5 portions, each receiving a different treatment; alkalisation, protease inhibiter, boric acid, low protein binding tubes and no treatment (control). Samples were stored at −20 °C and −80 °C and ACR was analysed again after 12 months. Results Mean (95% CI) percent change in ACR was −34.3% (−47.2 to −21.4; p < 0.0001) and −1.8% (−9.4 to 5.8; p = 0.91) in samples stored at −20 °C and −80 °C respectively. Treating samples did not prevent the reduction in albumin at −20 °C (p < 0.001). Conclusion The loss in urinary albumin concentration which occurs during storage at −20 °C for 12 months is not prevented by pre-treating samples prior to storage. For accurate determination of albumin concentration or ACR, samples should be stored at −80 °C on day of collection.

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“…Adrenocorticotropic hormone (ACTH) and aldosterone/renin samples must be transported rapidly to the laboratory for analysis [ 9 ]. A study showed that ACTH and aldosterone/renin samples could be studied for 6 hours at room temperature when taken under appropriate conditions [ 10 ]. In this study, all the samples were taken to the laboratory without waiting, centrifuged at –4°C, and stored at −80°C until analysis.…”

Section: Methodsmentioning

confidence: 99%

Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients

Orak

¹

,

Tolun

²

,

Bakacak

³

et al. 2021

Pain Research and Management

5

0

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Background. Pain aggravates the autonomic response to stress and raises neuroendocrine stress hormone levels. We compared the effects of propofol and sevoflurane on postoperative pain and neuroendocrine stress hormones. A prospective, randomized, and controlled trial was conducted with 60 patients. Methods. We randomly allocated patients to groups P (remifentanil/propofol, n = 30) and S (remifentanil/sevoflurane, n = 30). Preoperative blood samples were taken to measure serum adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), glucagon, cortisol, aldosterone, and prostaglandin E2 (PGE2) levels. Intraoperatively and postoperatively, clinical parameters were monitored at different time points. The hormone levels were again measured in the follicular fluid and blood postoperatively. Result. Demographic data were similar. The preoperative serum aldosterone levels were significantly higher in group P ( p = 0.001 ). Preoperative and postoperative serum ACTH, glucagon, cortisol, and PGE2 levels were significantly different in group P ( p = 0.009 , p = 0.004 , p = 0.029 , and p = 0.002 ); serum ACTH, glucagon, and PGE2 levels increased while serum cortisol levels decreased postoperatively. In group S, serum CRH and aldosterone levels, both increased in the postoperative period compared to the preoperative ( p = 0.001 , p = 0.006 ). Postoperatively, glucagon and PGE2 levels were both higher in group P than group S ( p = 0.019 , p = 0.015 ). In postoperative follicular fluid, glucagon and PGE2 levels were higher in group P, while cortisol levels were higher in group S ( p = 0.001 , p = 0.007 , and p = 0.001 ). Conclusion. The effects of anesthetic agents were different. In group P, in the preoperative and postoperative evaluation, ACTH, glucagon, and PGE2 increased postoperatively, while cortisol decreased. In group S, aldosterone and CRH increased postoperatively. Glucagon and PG E2 were higher in group P than S, postoperatively.

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Current laboratory requirements for adrenocorticotropic hormone and renin/aldosterone sample handling are unnecessarily restrictive

Cited by 13 publications

References 12 publications

Survey of renin and aldosterone testing practices by Ontario laboratories – Providing insight into best practices

Survey of renin and aldosterone testing practices by Ontario laboratories – Providing insight into best practices

Stability of urinary albumin and creatinine after 12 months storage at −20 °C and −80 °C

Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients

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Current laboratory requirements for adrenocorticotropic hormone and renin/aldosterone sample handling are unnecessarily restrictive

Cited by 13 publications

References 12 publications

Survey of renin and aldosterone testing practices by Ontario laboratories – Providing insight into best practices

Survey of renin and aldosterone testing practices by Ontario laboratories – Providing insight into best practices

Stability of urinary albumin and creatinine after 12 months storage at −20 °C and −80 °C

Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients

Contact Info

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Stability of urinary albumin and creatinine after 12 months storage at −20 °C and −80 °C