Kinins in relation to renin activity in renal and inferior caval veins in normal individuals and patients with primary aldosteronism

1981 ◽  
Vol 96 (2) ◽  
pp. 235-242 ◽  
Author(s):  
Lennart Hulthén ◽  
Kjell Jonsson ◽  
Harry Lecerof ◽  
Bernt Hökfelt
Keyword(s):  
Primary Aldosteronism ◽  
Renal Vein ◽  
Statistical Significance ◽  
Left Renal Vein ◽  
Plasma Renin ◽  
Renin Activity ◽  
Renal Veins ◽  
Plasma Aldosterone Concentration ◽  
Normal Individuals ◽  
The Right

Abstract. Blood kinin concentration and plasma renin activity (PRA) were determined in the renal veins and in the inferior caval vein (ICV) below the level of the renal veins in 9 normal individuals (5 men and 4 women) and 7 patients with primary aldosteronism (3 men and 4 women). PRA in the renal veins and ICV was significantly lower and plasma aldosterone concentration in ICV significantly higher in the patients as compared to the normals. Kinin concentration in the renal veins and ICV did not differ significantly between the patients and the normals (0.31 ± 0.04 (mean ± sem) vs 0.45 ± 0.03 and 0.27 ± 0.05 vs 0.45 ± 0.06 μg/l, respectively). In the normal individuals kinin concentration and PRA were inversely related in the left renal vein (r = −0.80; P < 0.02), whereas this relation did not reach statistical significance in the right renal vein (r = −0.60; P < 0.10). Kinin concentration in both renal veins was positively correlated to kinin concentration in ICV (r = 0.73; P < 0.05 and r = 0.83; P < 0.02 for the right and left renal vein, respectively). These results indicate that intrarenal kinin formation and renin release are inversely related in normal subjects. Furthermore, they suggest that one and the same enzyme, possibly renal kallikrein, may be implicated in the kinin formation in the systemic as well as in the renal circulation. Intrarenal kinin formation seems not to be increased in primary aldosteronism.

scholarly journals Effects of Ramipril on the Aldosterone/Renin Ratio and the Aldosterone/Angiotensin II Ratio in Patients With Primary Aldosteronism

Hypertension ◽  
2020 ◽  
Vol 76 (2) ◽  
pp. 488-496 ◽  
Author(s):  
Zeng Guo ◽  
Marko Poglitsch ◽  
Diane Cowley ◽  
Oliver Domenig ◽  
Brett C. McWhinney ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Plasma Renin Activity ◽  
Ace Inhibitors ◽  
Primary Aldosteronism ◽  
Characteristic Curve ◽  
False Negative ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Renin Activity ◽  
Plasma Aldosterone Concentration

The aldosterone/renin ratio (ARR) is currently considered the most reliable approach for case detection of primary aldosteronism (PA). ACE (Angiotensin-converting enzyme) inhibitors are known to raise renin and lower aldosterone levels, thereby causing false-negative ARR results. Because ACE inhibitors lower angiotensin II levels, we hypothesized that the aldosterone/equilibrium angiotensin II (eqAngII) ratio (AA2R) would remain elevated in PA. Receiver operating characteristic curve analysis involving 60 patients with PA and 40 patients without PA revealed that the AA2R was not inferior to the ARR in screening for PA. When using liquid chromatography-tandem mass spectrometry to measure plasma aldosterone concentration, the predicted optimal AA2R cutoff for PA screening was 8.3 (pmol/L)/(pmol/L). We then compared the diagnostic performance of the AA2R with the ARR among 25 patients with PA administered ramipril (5 mg/day) for 2 weeks. Compared with basally, plasma levels of equilibrium angiotensin I (eqAngI) and direct renin concentration increased significantly ( P <0.01 or P <0.05) after ramipril treatment, whereas eqAngII and ACE activity (eqAngII/eqAngI) decreased significantly ( P <0.01). The changes of plasma renin activity and plasma aldosterone concentration in the current study were not significant. On day 14, 4 patients displayed false-negative results using ARR_direct renin concentration (plasma aldosterone concentration/direct renin concentration), 3 of whom also showed false-negative ARR_plasma renin activity (plasma aldosterone concentration/plasma renin activity). On day 15, 2 patients still demonstrated false-negative ARR_plasma renin activity, one of whom also showed a false-negative ARR_direct renin concentration. No false-negative AA2R results were observed on either day 14 or 15. In conclusion, compared with ARR which can be affected by ACE inhibitors causing false-negative screening results, the AA2R seems to be superior in detecting PA among subjects receiving ACE inhibitors.

scholarly journals Diagnostics of primary aldosteronism: is obligatory use of confirmatory tests justified?

2012 ◽  
Vol 13 (3) ◽  
pp. 367-371 ◽  
Author(s):  
Janusz Myśliwiec ◽  
Łukasz żukowski ◽  
Anna Grodzka ◽  
Agata Piłaszewicz ◽  
Szymon Drągowski ◽  
...  
Keyword(s):  
Plasma Renin Activity ◽  
Primary Aldosteronism ◽  
Plasma Renin ◽  
Cost Effective ◽  
Plasma Aldosterone ◽  
Renin Activity ◽  
Plasma Aldosterone Concentration ◽  
Number Of Patients ◽  
Confirmatory Tests ◽  
Medical University

Introduction: Assessment of the renin-angiotensin-aldosterone system has been recently granted a much greater role in the evaluation of patients with arterial hypertension. There is no single test efficient in selection of patients for second-step etiological investigation. Methods: Altogether, 198 consecutive patients − 119 women (60%) and 79 men (40%) – hospitalized in years 2009–2011 at the Clinical Department of Endocrinology Medical University of Bialystok were diagnosed with primary aldosteronism. In each patient, plasma renin activity and plasma aldosterone concentration (basic and after 2 l NaCl infusion) were evaluated. Results: The percentage of patients with plasma aldosterone concentration ≥15 ng/ml was 53 and the percentage of patients with plasma renin activity ≤0.1 ng/ml/h was 20. The percentage of patients screened for primary aldosteronism in which the aldosterone:renin ratio exceeded consecutive cut-offs of 20, 30, 40 and 50 were respectively 57, 45, 34 and 29. Among 15 patients in which plasma aldosterone concentration after infusion of 2 l of saline was ≥6.5 ng/dl (8.6%), 13 (6.6%) were diagnosed with primary aldosteronism. Conclusion: The obligatory use of tests confirming autonomy of aldosterone secretion in patients screened for primary aldosteronism seems cost-effective in limiting the number of patients for further diagnosis.

Baseline Plasma Aldosterone Level and Renin Activity Allowing Omission of Confirmatory Testing in Primary Aldosteronism

2020 ◽  
Vol 105 (5) ◽  
pp. e1990-e1998 ◽  
Author(s):  
Junji Kawashima ◽  
Eiichi Araki ◽  
Mitsuhide Naruse ◽  
Isao Kurihara ◽  
Katsutoshi Takahashi ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Challenge Test ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Renin Activity ◽  
Plasma Aldosterone Concentration ◽  
Cutoff Value ◽  
Confirmatory Testing ◽  
Cutoff Values ◽  
Number Of Patients

Abstract Context Previous studies have proposed cutoff value of baseline plasma aldosterone concentration (bPAC) under renin suppression that could diagnose primary aldosteronism (PA) without confirmatory testing. However, those studies are limited by selection bias due to a small number of patients and a single-center study design. Objective This study aimed to determine cutoff value of bPAC and baseline plasma renin activity (bPRA) for predicting positive results in confirmatory tests for PA. Design The multi-institutional, retrospective, cohort study was conducted using the PA registry in Japan (JPAS/JRAS). We compared bPAC in patients with PA who showed positive and negative captopril challenge test (CCT) or saline infusion test (SIT) results. Patients Patients with PA who underwent CCT (n = 2256) and/or SIT (n = 1184) were studied. Main outcome measures The main outcomes were cutoff value of bPAC (ng/dL) and bPRA (ng/mL/h) for predicting positive CCT and/or SIT results. Results In patients with renin suppression (bPRA ≤ 0.3), the cutoff value of bPAC that would give 100% specificity for predicting a positive SIT result was lower than that for predicting a positive CCT result (30.85 vs 56.35, respectively). Specificities of bPAC cutoff values ≥ 30.85 for predicting positive SIT and CCT results remained high (100.0% and 97.0%, respectively) in patients with bPRA ≤ 0.6. However, the specificities of bPAC cutoff values ≥ 30.85 for predicting positive SIT and CCT results decreased when patients with bPRA &gt; 0.6 were included. Conclusion Confirmatory testing could be omitted in patients with bPAC ≥ 30.85 in the presence of bPRA ≤ 0.6.

scholarly journals Anatomical study of the renal veins observed during 342 living-donor nephrectomies

1997 ◽  
Vol 115 (3) ◽  
pp. 1456-1459 ◽  
Author(s):  
José Carlos Costa Baptista-Silva ◽  
Marcos José Veríssimo ◽  
Marcos Joaquim Castro ◽  
André Luiz Guimarães Câmara ◽  
José Osmar Medina Pestana
Keyword(s):  
Renal Vein ◽  
Living Donor ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Renal Veins ◽  
Gonadal Vein ◽  
The Right

The anatomical variations of renal veins observed during 342 nephrectomies in living donors are described, 311 cases on the left side and 31 on the right. The following anatomy of the renocava veins was observed: 1. On the left side the renal vein was always unique (311/311) and had two tributaries (suprarenal and gonadal veins) in 100 per cent and one or more renolumbar veins in 65.27 per cent, encircling the aorta in 1.07 per cent, was retroaortic in 1.4 per cent; and the inferior vena cava was double in 0.64 per cent; B- on the right side the renal vein was double in 29 per cent (9/31) and had only one tributary (gonadal vein) in one case, for 3.22 per cent (1/ 31); three or more renal veins in 9.7 per cent (3/31). We concluded that the left renal vein is always unique, presenting variations principally in its tributaries and trajectory. On the right side, the renal vein was double or triple in 38.79 per cent

Primary Reninism: Hypertension, Hyperreninaemia and Secondary Aldosteronism Due to Juxtaglomerular Renal Cell Tumours

1973 ◽  
Vol 45 (s1) ◽  
pp. 279s-282s
Author(s):  
J. W. Conn ◽  
E. L. Cohen ◽  
W. J. McDonald ◽  
W. M. Blough ◽  
C. P. Lucas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Cell ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Cell Tumour ◽  
Renin Activity ◽  
Juxtaglomerular Cell ◽  
The Right ◽  
Renal Cell Tumours ◽  
Biochemical Abnormalities

1. A further case of renin-secreting renal juxtaglomerular cell tumour is reported. 2. Hypertension, aldosteronism and hypokalaemia were associated with high peripheral levels of renin. 3. Renin activity was twice as high in right as in left renal vein plasma. 4. A renal juxtaglomerular cell tumour was found in the right kidney and removed, after which the biochemical abnormalities and blood pressure were promptly corrected. 5. Explants of tumour tissue in culture produced large amounts of renin.

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