Ferrari Paolo, Shaw Sidney G, Nicod Jérôme, Saner Esther, Nussberger Jürg
Department of Nephrology, Fremantle Hospital, University of Western Australia, Fremantle, Australia.
J Hypertens. 2004 Feb;22(2):377-81. doi: 10.1097/00004872-200402000-00023.
In recent years, the assessment of the plasma aldosterone-to-renin ratio (ARR) has become an established screening method for the diagnosis of primary aldosteronism. Plasma renin activity (PRA) is usually measured to define ARR although, increasingly, renin concentration alone is often measured in clinical routine.
To determine the threshold of ARR using active renin concentration to screen for primary aldosteronism.
To determine the ARR threshold based on plasma immunoreactive renin concentration (irR), we measured plasma aldosterone concentration (PAC), irR and PRA in 36 hypertensive patients, nine thereof with adrenal adenoma, and compared ARRs calculated from irR and PRA, respectively.
Single-centre, hypertension clinic in a tertiary care hospital.
PRA ranged from 0.41-14.9 ng/ml per h and irR from 1.1-72 ng/l. There was an excellent correlation between PRA and irR (r = 0.98, P < 0.0001) and between ARRPRA and ARRirR (r = 0.96, P < 0.0001). An ARRPRA > 750 pmol/l per ng/ml per h was previously found to be highly predictive of primary aldosteronism because 90% of the corresponding patients failed to suppress PAC upon saline infusion or fludrocortisone. The corresponding threshold value for ARRirR was 150 pmol/ng in our patients. Using these cut-offs, nine subjects had both increased ARRPRA and ARRirR while, in three patients, either ARRPRA or ARRirR were increased. The nine patients with increased ARRPRA and ARRirR also had PAC > 650 pmol/l. Only these patients had adrenal adenomas.
The ARR threshold to screen for primary aldosteronism may be based on measurement of irR. An ARRirR > 150 pmol/ng may indicate primary aldosteronism.
近年来，血浆醛固酮与肾素比值（ARR）的评估已成为诊断原发性醛固酮增多症的既定筛查方法。通常通过测量血浆肾素活性（PRA）来定义ARR，不过在临床实践中，越来越多地仅测量肾素浓度。
确定使用活性肾素浓度筛查原发性醛固酮增多症时ARR的阈值。
为了基于血浆免疫反应性肾素浓度（irR）确定ARR阈值，我们测量了36例高血压患者的血浆醛固酮浓度（PAC）、irR和PRA，其中9例患有肾上腺腺瘤，并分别比较了由irR和PRA计算得出的ARR。
一家三级医院的单中心高血压诊所。
PRA范围为每小时0.41 - 14.9 ng/ml，irR范围为1.1 - 72 ng/l。PRA与irR之间以及ARR（PRA）与ARR（irR）之间存在极好的相关性（r = 0.98，P < ＜0.0001）以及（r = 0.96，P < ＜0.0001）。先前发现ARR（PRA）> 750 pmol/l每ng/ml每小时对原发性醛固酮增多症具有高度预测性，因为相应患者中有90%在输注生理盐水或氟氢可的松后未能抑制PAC。在我们的患者中，ARR（irR）的相应阈值为150 pmol/ng。使用这些临界值，9名受试者的ARR（PRA）和ARR（irR）均升高，而在3名患者中，ARR（PRA）或ARR（irR）升高。9名ARR（PRA）和ARR（irR）升高的患者的PAC也> 650 pmol/l。只有这些患者患有肾上腺腺瘤。
筛查原发性醛固酮增多症的ARR阈值可基于irR的测量。ARR（irR）> 150 pmol/ng可能提示原发性醛固酮增多症。
