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Aldosterone And Renin - Indications For Testing And Pre-Analytical Requirements

Atche Nedzhib, Zinaida Ivanova, Yana Bocheva


Introduction: According to WHO data, high blood pressure is the most common chronic disease that causes 7.5 million or 12.8% of all deaths yearly on a global scale. The renin-angiotensin-aldosterone system (RAAS) plays a significant role in preserving hemodynamic stability in response to the loss of blood volume, salt and water.

Aim: A blood renin test is usually ordered to detect the cause of increased blood pressure, insufficient response to antihypertensive therapy and low blood potassium levels. Indications for aldosterone measurements are intended for use in the diagnosis and treatment of primary aldosteronism, hypertension caused by primary aldosteronism, selective hypoaldosteronism, edematous states and other conditions of electrolyte imbalance. Since renin and aldosterone are so closely related, both substances are often tested together as aldosterone-to-renin ratio (ARR).

Materials and Methods: The levels of renin and aldosterone are being tested in the Clinical Laboratory at the St. Marina University Hospital, with an automated immunochemical analyzer LIASON®, DIASORIN, which uses chemiluminescent immunoassay (CLIA) technology. For screening renin and aldosterone levels EDTA plasma and 24-hour urine collection are used.

Results: Reference ranges of renin and aldosterone tests can be affected by body position when blood is drawn, salt intake, stress, pregnancy,variety of prescribed medications and supplements – corticosteroids, estrogens, caffeine, beta blockers, vasodilators, diuretics, ACE inhibitors. The normal value range for aldosterone in plasma is: 0.6-0.98 nmol/L for upright position, and 0.03-0.65 nmol/L – in a lying down position; aldosterone in the urine - 1.19-28.1 μg/24h. The normal value range for plasma renin is: 4.4-46.1 in IU/mL – upright position and 2.8-39.9 in IU/mL – in a lying down position.

Conclusion: Measuring renin and aldosterone levels is used as a screening test for diagnosis and treatment of hyperaldosteronism and hypertension. A score within a reference range does not exclude the presence of a disease and it should be interpreted in conjunction with the patient's clinical picture and other diagnostic procedures. In order to achieve reliable results, precise technique and strict observance of the pre-analytical requirements are required.


renin, angiotensin, RAAS

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Физиология на човека. Учебник за студенти по медицина, п/р на Л. Витанова и Р. Гърчев, МИ „Арсо“, 2008.

Биохимия : За медици и стоматолози, Ангел Ангелов, Кирана Данчева, Александра Кръшкова, Любен Сираков; Ред. Емануил Гачев, Тодор Николов. УИ „Св. Климент Охридски“, 1995.

Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 12e



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