What is the role of the plasma aldosterone/plasma renin activity ratio after salt and water depletion and/or upright posture in the workup of primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

In primary aldosteronism, PRA is less than 1 ng/mL/h and fails to rise above 2 ng/mL/h following salt and water depletion, furosemide administration, or 4 hours of erect posture. This test, along with the captopril suppression tests, has been used either as a screening test or as a confirmatory (second-tier) test for primary aldosteronism, depending on personal preferences of various groups involved in primary aldosteronism research.

Confirmatory tests are based on the concept that aldosterone is secreted in an unregulated fashion in primary aldosteronism and therefore cannot be suppressed by usual physiologic regulatory inputs. In a similar fashion, the PRA is chronically and tonically suppressed and cannot be stimulated


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