Which urine specimen findings may indicate hyperaldosteronism?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

A 24-hour urine specimen should be collected for sodium and potassium measurement. If the urine sodium level is more than 100 mmol/L and urine potassium is less than 30 mmol/L, hyperaldosteronism is unlikely.

If urinary potassium exceeds 30 mmol/L, the patient should have plasma renin activity measured. If the PRA is high, the likely cause is estrogen therapy, renovascular hypertension, malignant hypertension, or salt-wasting renal disease (or blockade of the renin-angiotensin system—the far more common reason). In the presence of low PRA, the serum aldosterone level can be measured (aldosterone and renin should be measured together; separate measurements will lead to inaccuracy). A low aldosterone level indicates licorice ingestion or other mineralocorticoid ingestion. A high aldosterone level indicates primary hyperaldosteronism.


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