Key result
In patients with primary aldosteronism, renal cysts were significantly more prevalent in those with high-normal renin compared to those with low to low-normal renin (90.9% vs 56.0%, P=0.027).
Why the study?
Non-suppressed renin can cause false-negative primary aldosteronism screening results, prompting investigation into whether renal cysts are associated with non-suppressed plasma renin.
Does the presence of renal cysts cause non-suppression of renin in patients with primary aldosteronism?
Observational (n=114)
No
Does the presence of renal cysts cause non-suppression of renin in patients with primary aldosteronism?
Renal cysts are common in patients with primary aldosteronism and may cause non-suppressed renin, potentially leading to false-negative screening results, particularly in patients aged 50 years or younger.
Renal cysts may confound PA screening in younger patients; leaves open whether cyst assessment refines diagnostic thresholds.
BACKGROUND: Screening for primary aldosteronism is based on measuring aldosterone-to-renin ratio. Non-suppressed renin may cause false negative screening results, and such patients may miss focused, potentially curable treatment. We investigated the association between renal cysts and non-suppressed plasma renin. METHODS: Altogether, 114 consecutive patients with confirmed primary aldosteronism undergoing adrenal vein sampling were prospectively recruited between October 7, 2020 and December 30, 2021. During the procedure, plasma samples for renin analyses were collected from the right and left renal veins and the inferior vena cava. Renal cysts were identified using contrast-enhanced computed tomography. RESULTS: Renal cysts were found in 58.2% of the 114 patients. Neither screening nor renal vein renin concentrations were significantly different in patients with and without cysts, or when the kidneys with and without cysts were evaluated. However, cysts were significantly more prevalent in the "high-normal renin" group (cut point 23.0 mU/L) than in the "low to low-normal renin" group (90.9%, n = 11 vs. 56.0%, n = 102, P = .027, respectively). All patients ≤50 years of age in the "high-normal renin" group had renal cysts. Strong correlations were found between renin concentrations in the right and left renal veins (r = .984), and between renin concentration and renin activity in the inferior vena cava (r = .817). CONCLUSION: Renal cysts are found in the majority of patients with primary aldosteronism, and they may interfere with diagnostics, especially in patients aged 50 years or less. In patients with non-suppressed renin due to renal cysts, aldosterone-to-renin ratio below the diagnostic threshold does not always exclude the diagnosis of primary aldosteronism.
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Ylänen et al. (2023) conducted an observational in primary aldosteronism (n=114). High-normal renin (≥23.0 mU/L) vs. Low to low-normal renin was evaluated on Presence of renal cysts (p=.027). In patients with primary aldosteronism, renal cysts were significantly more prevalent in those with high-normal renin compared to those with low to low-normal renin (90.9% vs 56.0%, P=0.027).
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