What is the role of aldosterone-to-renin ratio (ARR ... - Medscape

The aldosterone-to-renin ratio (ARR)—that is, the ratio of plasma aldosterone (expressed in ng/dL) to plasma renin activity (PRA, expressed in ng/mL/h)—is ... ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint  Specialty: Multispecialty Allergy&Immunology Anesthesiology BusinessofMedicine Cardiology CriticalCare Dermatology Diabetes&Endocrinology EmergencyMedicine FamilyMedicine Gastroenterology GeneralSurgery Hematology-Oncology HIV/AIDS HospitalMedicine InfectiousDiseases InternalMedicine Multispecialty Nephrology Neurology Ob/Gyn&Women'sHealth Oncology Ophthalmology Orthopedics Pathology&LabMedicine Pediatrics PlasticSurgery Psychiatry PublicHealth PulmonaryMedicine Radiology Rheumatology Transplantation Urology MedicalStudents Nurses Pharmacists Residents TodayonMedscape Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS UK LogIn SignUpIt'sFree! Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS UK Register LogIn NoResults NoResults Monday,November29,2021 ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint close PleaseconfirmthatyouwouldliketologoutofMedscape. Ifyoulogout,youwillberequiredtoenteryourusernameandpasswordthenexttimeyouvisit. Logout Cancel https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvOTIwNzEzLTY4NzYyL3doYXQtaXMtdGhlLXJvbGUtb2YtYWxkb3N0ZXJvbmUtdG8tcmVuaW4tcmF0aW8tYXJyLWluLXRoZS1kaWFnbm9zaXMtb2YtaHlwZXJhbGRvc3Rlcm9uaXNt processing.... Drugs&Diseases > Pediatrics:GeneralMedicine > HyperaldosteronismQ&A Whatistheroleofaldosterone-to-reninratio(ARR)inthediagnosisofhyperaldosteronism? Updated:Sep08,2020 Author:GeorgePChrousos,MD,FAAP,MACP,MACE,FRCP(London);ChiefEditor:RobertPHoffman,MD more... References Share Email Print Feedback Close Facebook Twitter LinkedIn WhatsApp Answer Thealdosterone-to-reninratio(ARR)—thatis,theratioofplasmaaldosterone(expressedinng/dL)toplasmareninactivity(PRA,expressedinng/mL/h)—isthemostsensitivemeansofdifferentiatingprimaryfromsecondarycausesofhyperaldosteronism.Itcanbeobtainedunderrandomconditionsofsodiumintake. Theprinciplebehindthistestisthatasaldosteronesecretionrises,PRA(whichmeasurestherateofproductionofangiotensinIfromendogenousangiotensinogen)inexvivotestingshouldfallbecauseofsodiumretention.Thisnegativefeedbackresponseshouldoccurwhenthealdosteronelevelsaresupraphysiologicforthatindividualpatient,andPRAmayfallwellbeforeplasmaaldosteroneisclearlyincreased. Valuesobtainedintheuprightposition(ie,withthepatientstandingfor2h)aremoresensitivethansupinetestresults.Patientsshouldbeencouragednottorestrictsaltintakeandhypokalemiashouldbecorrectedbeforetestingbecauselowpotassiumsuppressesaldosteronesecretion.MostauthorsrecommendanARRof20-40,whereasanARRofatleast35has100%sensitivityand92.3%specificityindiagnosingPA.SomeinvestigatorsrequireelevatedaldosteronelevelsinadditiontoelevatedARRforapositivescreeningtestforPA(usuallyaldosterone>15ng/dL).Againstaformalcut-offlevelforaldosteronearethefindingsofseveralstudies,indicatingthat36–48%ofindividualswithPAhaveplasmaaldosteronelevelsbetween9–16ng/dLandapproximately20%ofindividualswithunilateralautonomousadrenalaldosteroneproductionhavelevelslessthan15ng/dL. [5,24,26,27] ReadMore Didthisansweryourquestion? Yes No Additionalfeedback?(Optional) Submit Thankyouforyourfeedback! RelatedQuestions:   References DominguezA,MuppidiV,GuptaS.Hyperaldosteronism.StatPearls.2020Jan.[Medline].[FullText]. 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Physiologicregulationoftherenin-angiotensin-aldosteroneaxis. of 2 Tables BacktoList ContributorInformationandDisclosures Author GeorgePChrousos,MD,FAAP,MACP,MACE,FRCP(London) ProfessorandChair,FirstDepartmentofPediatrics,AthensUniversityMedicalSchool,AghiaSophiaChildren'sHospital,Greece;UNESCOChaironAdolescentHealthCare,UniversityofAthens,Greece GeorgePChrousos,MD,FAAP,MACP,MACE,FRCP(London)isamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,AmericanCollegeofPhysicians,AmericanPediatricSociety,AmericanSocietyforClinicalInvestigation,AssociationofAmericanPhysicians,EndocrineSociety,PediatricEndocrineSociety,SocietyforPediatricResearch,AmericanCollegeofEndocrinologyDisclosure:Nothingtodisclose. Coauthor(s) AmaliaSertedaki,PhD ResearchAssociate,MolecularEndocrinologyLaboratory,DivisionofEndocrinology,DiabetesandMetabolism,FirstDepartmentofPediatrics,AghiaSophiaChildren'sHospital,UniversityofAthensMedicalSchool,GreeceDisclosure:Nothingtodisclose. EleniMagdaliniKyritsi,MD,PhD ClinicalResidentinEndocrinology,DivisionofEndocrinology,MetabolismandDiabetes,FirstDepartmentofPediatrics,"AghiaSophia"Children'sHospital,UniversityofAthensMedicalSchool,GreeceDisclosure:Nothingtodisclose. ChiefEditor RobertPHoffman,MD ProfessorandProgramDirector,DepartmentofPediatrics,OhioStateUniversityCollegeofMedicine;PediatricEndocrinologist,DivisionofPediatric,Endocrinology,Diabetes,andMetabolism,NationwideChildren'sHospital RobertPHoffman,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPediatricians,AmericanDiabetesAssociation,AmericanPediatricSociety,ChristianMedicalandDentalAssociations,EndocrineSociety,MidwestSocietyforPediatricResearch,PediatricEndocrineSociety,SocietyforPediatricResearchDisclosure:Nothingtodisclose. Acknowledgements AntonyLafferty,MBChB,FRACPSeniorLecturerofPediatricEndocrinology,MonashUniversityDepartmentofPediatrics,NationalInstitutesofHealth,Bethesda,MD,andPrincessMargaretHospitalforChildren,Perth,WesternAustralia AntonyLafferty,MBChB,FRACPisamemberofthefollowingmedicalsocieties:EndocrineSociety Disclosure:Nothingtodisclose. LynneLiptonLevitsky,MDChief,PediatricEndocrineUnit,MassachusettsGeneralHospital;AssociateProfessorofPediatrics,HarvardMedicalSchool LynneLiptonLevitsky,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyofPediatrics,AmericanDiabetesAssociation,AmericanPediatricSociety,EndocrineSociety,PediatricEndocrineSociety,andSocietyforPediatricResearch Disclosure:PfizerGrant/researchfundsP.I.;TercicaGrant/researchfundsOther;EliLilyGrant/researchfundsPI;NovoNordiskGrant/researchfundsPI;NovoNordiskConsultingfeeConsulting;OnyxHeartValveConsultingfeeConsulting ThomasAWilson,MDProfessorofClinicalPediatrics,ChiefandProgramDirector,DivisionofPediatricEndocrinology,DepartmentofPediatrics,TheSchoolofMedicineatStonyBrookUniversityMedicalCenter ThomasAWilson,MDisamemberofthefollowingmedicalsocieties:EndocrineSociety,PediatricEndocrineSociety,andPhiBetaKappa Disclosure:Nothingtodisclose. 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