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Hepburn S, Munday C, Taylor K, Halsall DJ. Stability of direct renin concentration and plasma renin activity in EDTA whole blood and plasma at ambient and refrigerated temperatures from 0 to 72 hours. Clin Chem Lab Med 2022; 60:1384-1392. [PMID: 35785453 DOI: 10.1515/cclm-2022-0375] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine the appropriate transport and storage conditions for blood taken for direct renin concentration and plasma renin activity measurement, and whether cryoactivation of prorenin is seen at time points relevant to clinical practice. METHODS Blood was extracted from n=10 volunteers into K2-EDTA tubes. Stability of renin was assessed in whole blood stored at room temperature (15-25 °C) and in the refrigerator (2-8 °C) at 0 h, 8 h, and 24 h. The stability of renin in plasma was determined under the same conditions at 0 h, 24 h and 72 h. RESULTS Stability of plasma renin activity and direct renin concentration in whole blood stored at room temperature was found to be acceptable for up to 24 h. At refrigerated temperature, whole blood stability was acceptable for measurement of direct renin concentration up to 8 h and plasma renin activity up to 24 h. In contrast, plasma renin activity was not stable in plasma stored at either room or refrigerated temperatures up to 24 h; however, direct renin concentration had acceptable stability in plasma stored at room temperature for up to 24 h, but stability was unacceptable at refrigerated temperatures. CONCLUSIONS Samples collected for plasma renin activity and direct renin concentration should be transported as whole blood to optimise stability. After sample processing, plasma can be kept at room temperature for up to 24 h for direct renin concentration, however, for determination of plasma renin activity separated plasma should be analysed or frozen as soon as possible.
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Affiliation(s)
| | | | - Kevin Taylor
- Blood Sciences, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - David J Halsall
- Blood Sciences, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
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Rutledge AC, Johnston A, Bailey D, Booth RA, Edmond P, Leung V, Veljkovic K. Survey of renin and aldosterone testing practices by Ontario laboratories - Providing insight into best practices. Pract Lab Med 2021; 25:e00229. [PMID: 34095415 PMCID: PMC8145751 DOI: 10.1016/j.plabm.2021.e00229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Angela C Rutledge
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada
| | - Anna Johnston
- Institute for Quality Management in Healthcare, Toronto, Ontario, Canada
| | - Dana Bailey
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Dynacare, Brampton, Ontario, Canada
| | - Ronald A Booth
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Pamela Edmond
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada
| | - Victor Leung
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Laboratory Medicine, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Kika Veljkovic
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,LifeLabs, Toronto, Ontario, Canada
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Fu Y, Ge S, Qiu X, Cui R, Zhang C, Xu X, Li J, Feng J, Bai J, Sun M, Liu W. Effect of sample delivery conditions on Renin-Angiotensin-Aldosterone System (RAAS) assay. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:336-342. [PMID: 32189531 DOI: 10.1080/00365513.2020.1741675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Renin-Angiotensin-Aldosterone System (RAAS) measurements are influenced by several factors. We investigated the effect of sample delivery conditions on RAAS measurements including sample storage temperature and time. Blood samples were collected from thirty participants using enzyme inhibitor tubes and serum separation gel evacuated tubes. Plasma and serum from fresh blood samples without further storage (as baseline), and from blood samples that were stored at either 0 °C, 4 °C, or 25 °C for 3 h, 6 h and 24 h, respectively, were extracted and stored at -30 °C for batch measurements using radioimmunoassay. Concentrations of Aldosterone (Ald) decreased following delivery temperature and time, and were significantly different when samples were set aside at 0 °C for 24 h (p < .01), 4 °C for 6 h (p < .01), and 25 °C for 3 h (p < .05). However, levels of Angiotensin (Ang I) increased following delivery temperature and time, and were significantly different when samples were set aside at 0 °C and 4 °C for 6 h (p < .05) and at 25 °C for 3 h (p < .001). However, no changes were observed for the concentrations of plasma renin activity (PRA) and Ang II, except for Ang II which increased significantly when samples were set aside at 25 °C for 24 h (p < .001). Our results indicate that samples used for RAAS measurement should be placed at a low temperature and analyzed as soon as possible after collection.
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Affiliation(s)
- Yu Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shibin Ge
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueting Qiu
- Departments of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rongrong Cui
- Department of Endocrinology, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an, China
| | - Chen Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xindan Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianlin Feng
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Min Sun
- Departments of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Abstract
Primary adrenal insufficiency (PAI) is a life-threatening disorder of adrenal cortex which is characterized by deficient biosynthesis of glucocorticoids, with or without deficiency in mineralocorticoids and adrenal androgens. Typical manifestations of primary adrenal insufficiency include hyperpigmentation, hypotension, hypoglycaemia, hyponatremia with or without hyperkalemia that are generally preceded by nonspecific symptoms at the onset. Recessively inherited monogenic disorders constitute the largest group of primary adrenal insufficiency in children. The diagnostic process of primary adrenal insufficiency includes demonstration of low cortisol concentrations along with high plasma ACTH and identifying the cause of the disorder. Specific molecular diagnosis is achieved in more than 80% of children with PAI by detailed clinical and biochemical characterization integrated with advanced molecular tools. Hormone replacement therapy determined on the type and the severity of deficient adrenocortical hormones is the mainstay of treatment. Optimized methods of steroid hormone delivery, improved monitoring of hormone replacement along with intensive education of patients and families on the rules during intercurrent illness and stress will significantly reduce the morbidity and mortality associated with primary adrenal insufficiency.
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Affiliation(s)
- Tarik Kirkgoz
- Marmara University School of Medicine, Department of Paediatric Endocrinology and Diabetes, Istanbul, Turkey.
| | - Tulay Guran
- Marmara University School of Medicine, Department of Paediatric Endocrinology and Diabetes, Istanbul, Turkey.
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Investigating the association of vitamin D with blood pressure and the renin–angiotensin–aldosterone system in hypertensive subjects: a cross-sectional prospective study. J Hum Hypertens 2017; 32:114-121. [DOI: 10.1038/s41371-017-0005-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
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Pescatello LS, Schifano ED, Ash GI, Panza GA, Corso LML, Chen MH, Deshpande V, Zaleski A, Cilhoroz B, Farinatti P, Taylor BA, O'Neill RJ, Thompson PD. Deep-targeted sequencing of endothelial nitric oxide synthase gene exons uncovers exercise intensity and ethnicity-dependent associations with post-exercise hypotension. Physiol Rep 2017; 5:e13510. [PMID: 29180482 PMCID: PMC5704084 DOI: 10.14814/phy2.13510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
Abstract
In previous studies, we found an endothelial nitric oxide synthase gene (NOS3) variant rs2070744 associated with the ambulatory blood pressure (BP) response following bouts of moderate and vigorous intensity acute exercise, termed post-exercise hypotension (PEH). In a validation cohort, we sequenced NOS3 exons for associations with PEH Obese (30.9 ± 3.6 kg.m-2) African American (n = 14) [AF] and Caucasian (n = 9) adults 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) performed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects were attached to an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing with the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for additional statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing-corrected P-values under time-adjusted linear models for 19 hourly BP measurements for each subject. After vigorous intensity over 19 h, among NOS3 variants passing multiple testing thresholds, as the #MA increased in rs891512 (P = 6.4E-04), rs867225 (P = 6.5E-04), rs743507 (P = 2.6E-06), and rs41483644 (P = 2.4E-04), systolic (SBP) decreased from 17.5 to 33.7 mmHg; and in rs891512 (P = 9.7E-05), rs867225 (P = 2.6E-05), rs41483644 (P = 1.6E-03), rs3730009 (P = 2.6E-04), and rs77325852 (P = 5.6E-04), diastolic BP decreased from 11.1 mmHg to 20.3 mmHg among AF only. In contrast, after moderate intensity over 19 h in NOS3 rs3918164, as the #MA increased, SBP increased by 16.6 mmHg (P = 2.4E-04) among AF only. NOS3 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. NOS3 should be studied further for its effects on PEH in a large, ethnically diverse sample of adults with hypertension to confirm our findings.
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Affiliation(s)
- Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
| | | | - Garrett I Ash
- School of Nursing, Yale University, New Haven, Connecticut
| | - Gregory A Panza
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Lauren M L Corso
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ved Deshpande
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Burak Cilhoroz
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Paulo Farinatti
- Department of Physical Activity Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Rachel J O'Neill
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut
| | - Paul D Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
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Pescatello LS, Schifano ED, Ash GI, Panza GA, Lamberti L, Chen MH, Deshpande V, Zaleski A, Farinatti P, Taylor BA, Thompson PD. Deep-targeted exon sequencing reveals renal polymorphisms associate with postexercise hypotension among African Americans. Physiol Rep 2016; 4:e12992. [PMID: 27940662 PMCID: PMC5064144 DOI: 10.14814/phy2.12992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/23/2022] Open
Abstract
We found variants from the Angiotensinogen-Converting Enzyme (ACE), Angiotensin Type 1 Receptor (AGTR1), Aldosterone Synthase (CYP11B2), and Adducin (ADD1) genes exhibited intensity-dependent associations with the ambulatory blood pressure (BP) response following acute exercise, or postexercise hypotension (PEH). In a validation cohort, we sequenced exons from these genes for their associations with PEH Obese (30.9 ± 3.6 kg m-2) adults (n = 23; 61% African Americans [AF], 39% Caucasian) 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) completed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects wore an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing using the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for further statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing corrected p-values under time adjusted linear models for 19 hourly BP measurements per subject. After vigorous intensity over 19 h among ACE, AGTR1, CYP11B2, and ADD1 variants passing multiple testing thresholds, as the #MA increased, systolic (SBP) and/or diastolic BP decreased 12 mmHg (P = 4.5E-05) to 30 mmHg (P = 6.4E-04) among AF only. In contrast, after moderate intensity over 19 h among ACE and CYP11B2 variants passing multiple testing thresholds, as the #MA increased, SBP increased 21 mmHg (P = 8.0E-04) to 22 mmHg (P = 8.2E-04) among AF only. In this replication study, ACE, AGTR1, CYP11B2, and ADD1 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. Renal variants should be explored further with a multi-level "omics" approach for associations with PEH among a large, ethnically diverse sample of adults with hypertension.
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Affiliation(s)
- Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut
| | | | - Garrett I Ash
- School of Nursing, Yale University, New Haven, Connecticut
| | - Gregory A Panza
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Lauren Lamberti
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ved Deshpande
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paulo Farinatti
- Department of Physical Activity Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paul D Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
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An automated assay for the clinical measurement of plasma renin activity by immuno-MALDI (iMALDI). BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2014; 1854:547-58. [PMID: 25461795 DOI: 10.1016/j.bbapap.2014.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/26/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022]
Abstract
Plasma renin activity (PRA) is essential for the screening and diagnosis of primary aldosteronism (PA), a form of secondary hypertension, which affects approximately 100 million people worldwide. It is commonly determined by radioimmunoassay (RIA) and, more recently, by relatively low-throughput LC-MS/MS methods. In order to circumvent the negative aspects of RIAs (radioisotopes, cross-reactivity) and the low throughput of LC-MS based methods, we have developed a high-throughput immuno-MALDI (iMALDI)-based assay for PRA determination using an Agilent Bravo for automated liquid handling and a Bruker Microflex LRF instrument for MALDI analysis, with the goal of implementing the assay in clinical laboratories. The current assay allows PRA determination of 29 patient samples (192 immuno-captures), within ~6 to 7h, using a 3-hour Ang I generation period, at a 7.5-fold faster analysis time than LC-MS/MS. The assay is performed on 350μL of plasma, and has a linear range from 0.08 to 5.3ng/L/s in the reflector mode, and 0.04 to 5.3ng/L/s in the linear mode. The analytical precision is 2.0 to 9.7% CV in the reflector mode, and 1.5 to 14.3% CV in the linear mode. A method comparison to a clinically employed LC-MS/MS assay for PRA determination showed excellent correlation within the linear range, with an R(2) value of ≥0.98. This automated high throughput iMALDI platform has clinically suitable sensitivity, precision, linear range, and correlation with the standard method for PRA determination. Furthermore, the developed workflow based on the iMALDI technology can be used for the determination of other proteomic biomarkers. This article is part of a Special Issue entitled: Medical Proteomics.
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Glinicki P, Jeske W, Gietka-Czernel M, Bednarek-Papierska L, Kruszyńska A, Słowińska-Srzednicka J, Zgliczyński W. The effect of blood collection procedure on plasma renin activity (PRA) and concentrations of direct renin (DRC) and aldosterone. J Renin Angiotensin Aldosterone Syst 2013; 16:339-43. [DOI: 10.1177/1470320313494434] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Piotr Glinicki
- Department of Endocrinology, The Medical Centre of Postgraduate Education, Poland
| | - Wojciech Jeske
- Department of Endocrinology, The Medical Centre of Postgraduate Education, Poland
| | | | | | | | | | - Wojciech Zgliczyński
- Department of Endocrinology, The Medical Centre of Postgraduate Education, Poland
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Horváth D, Lőcsei Z, Csizmadia Z, Toldy E, Szabolcs I, Rácz K. [Clinical evaluation of the renin-aldosterone system: comparison of two methods in different clinical conditions]. Orv Hetil 2012; 153:1701-10. [PMID: 23089169 DOI: 10.1556/oh.2012.29476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Measurement of plasma aldosterone/renin ratio is the key step in the diagnosis of primary aldosteronism. AIM The aim of the authors was to analyze and compare the diagnostic utility of plasma aldosterone/renin activity and plasma aldosterone/renin concentration ratios. METHODS Plasma aldosterone and plasma renin activity were determined by radioimmunoassays and plasma renin concentration was measured by immunoradiometric assay in 134 subjects (80 women and 54 men, aged 46±15.5 years) including 49 healthy blood donors (control group), 59 patients with hypertension (25 treated and 34 untreated) and 26 patients with incidentally discovered adrenal adenomas. RESULTS There was a weak correlation (r = 0.59) between plasma renin activity and plasma renin concentration in the lower range (plasma renin activity, 0.63±0.41 ng/ml/h; plasma renin concentration, 8.1±4.9 ng/l). Considering the cut-off value of plasma aldosterone/renin ratios determined in controls (plasma aldosterone/renin activity ratio, 30 ng/dl/ng/ml/h; plasma aldosterone/renin concentration ratio, 3.0 ng/dl/ng/l), high proportion of falsely positive results were found among patients on beta-receptor blocker therapy (plasma aldosterone/renin activity ratio, 22.2%; plasma aldosterone/renin concentration ratio, 44.4%) CONCLUSION The widely used plasma aldosterone/renin activity ratio can only be replaced with plasma aldosterone/renin concentration ratio with precaution on different clinical conditions.
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Affiliation(s)
- Dóra Horváth
- Vas Megyei Markusovszky Kórház, Egyetemi Oktatókórház Nonprofit Zrt. Általános Belgyógyászati Osztály, Szombathely
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12
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Abstract
BACKGROUND Congenital adrenal hyperplasia is a group of disorders caused by defects in the adrenal steroidogenic pathways. In its most common form, 21-hydroxylase deficiency, patients develop varying degrees of glucocorticoid and mineralocorticoid deficiency as well as androgen excess. Therapy is guided by monitoring clinical parameters as well as adrenal hormone and metabolite concentrations. CONTENT We review the evidence for clinical and biochemical parameters used in monitoring therapy for congenital adrenal hyperplasia. We discuss the utility of 24-h urine collections for pregnanetriol and 17-ketosteroids as well as serum measurements of 17-hydroxyprogesterone, androstenedione, and testosterone. In addition, we examine the added value of daily hormonal profiles obtained from salivary or blood-spot samples and discuss the limitations of the various assays. SUMMARY Clinical parameters such as growth velocity and bone age remain the gold standard for monitoring the adequacy of therapy in congenital adrenal hyperplasia. The use of 24-h urine collections for pregnanetriol and 17-ketosteroid may offer an integrated view of adrenal hormone production but target concentrations must be better defined. Random serum hormone measurements are of little value and fluctuate with time of day and timing relative to glucocorticoid administration. Assays of daily hormonal profiles from saliva or blood spots offer a more detailed assessment of therapeutic control, although salivary assays have variable quality.
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Affiliation(s)
- Andrew Dauber
- Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA
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