Primary Aldosteronism (PA) is the most common secondary cause of hypertension and there is a potential surgical cure. Endocrine Society guidelines recommend universal aldosterone renin ratio (ARR) screening for all hypertensive subjects. ARR interpretation is difficult in the chronic kidney disease (CKD) population in whom hypertension is prevalent. Renally cleared aldosterone metabolites cross react in commonly used chemiluminescent immunoassay systems (CLIA), renin synthesis is affected, and subjects are often prescribed multiple interfering medications. Saline infusion tests (SIT) are often not practical. We report three patients with CKD referred for PA investigation. Dual aldosterone analysis by CLIA and liquid chromatography mass spectrometry (LCMS) methods were applied to ARR and adrenal venous sampling (AVS).
Thomas et al. (Sun,) studied this question.