Guest guest Posted April 19, 2004 Report Share Posted April 19, 2004 do you have the exact numbers? Patients with PA would be expected to have a decrease in renin and aldo with salt loading but if renin is very low to start it might appear to increase by chance. The aldo would be expected to go down as well. Spiro would make renin go up and aldo up even more. -- May your pressure be low! CE Grim MD Clinical Professor of Internal Medicine Professor of Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertenision Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2004 Report Share Posted April 23, 2004 In a message dated 4/23/2004 9:27:57 AM Eastern Daylight Time, spirlhelix@... writes: > Hi, Dr. Grim > > In response to your question about my odd test > results, my nephrologist has a theory that the > Lisinopril 20 mg and Diovan 360 mg caused my renin to > increase. So my renin is higher than it might > otherwise be in relation to aldosterone. This is a reasonable suggestion. Also Spiro can increase the renin. This is the reason it is important to try to get these tests before any meds are started. > > I'm not sure what my urine potassium would be expected > to do if I had PA, on a salt loading 24 hour urine > test. Can you clarify this? Yes the urine K should be high. but need serum K at the same time to interpret. > > Here are the numbers they came up with, on salt > loading 3000 mg Na daily for 3 days. > > Aldosterone, urine 24 hours: 16.2 ug/24 hrs. > Reference interval, high sodium intake: 0-6 ug/24 hrs. How much sodium was in the urine? How much K was in the 24 hr urine. > > Aldosterone, serum (after Na loading): 16.2 > reference interval, upright or supine unspecified: > less than 1.6-31.0 ng/dl I would say this is high. > > Renin, serum (also after Na loading): 8.2 This is not low and most likely due to drugs. > > reference interval, upright, normal sodium diet: > 0.5-4.0 > > They also ran 24-hour creatinine clearance at the same > time and found the kidney function 50-60% of normal. > I'm not sure how that might affect the tests. Also, I > wonder if heart failure might have any effect. I only > went 2 weeks and three days without Spironolactone, > and I started getting BP readings in at stroke level > (200/115). So this is a " rush " test, and > Spironolactone washout was not complete. I'm not sure > how all these factors apply. Are you sure you collected every drop of urine for a full 24 hours? If not your kidney function will appear low when it is not and the urine Na and K and aldo will not be accurate. Tell your Dr if you did and the exact time that the urine was collected in hours and minutes. Why are you not just staying on Spiro? + whatever else it takes to control BP. If it does it alone that is OK. If it controls the BP anyway I would just sit with this. > > Your thoughts will be most welcome. > > Warmly, > > Pam > > > > > > > > --- lowerbp2@... wrote: > > do you have the exact numbers? > > > > Patients with PA would be expected to have a > > decrease in renin and aldo with salt loading but if > > renin is very low to start it might appear to > > increase by chance. The aldo would be expected to May your pressure be low! CE Grim MD Clinical Professor of Internal Medicine Professor of Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertenision Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2004 Report Share Posted April 23, 2004 In a message dated 4/23/2004 11:40:36 AM Eastern Daylight Time, spirlhelix@... writes: > The cardiologists (for heart failure) and nephrologist > (for glomerulonephritis) are pretty clear they want me > to stay on these meds. Just trying to keep the heart > and kidneys working slow so's I won't need transplants > any time soon. The key way to keep your kidneys and heart going is to keep the BP at goal which for you should be below 130/80 or at home 125/75. How much protein is in your urine now? Has the ejection fraction been redone since your BP is normal? May want to wait for a couple of months. I would expect it to return to normal. The high K is compatible with excess aldo. What was the blood K around the time you did the urine? May your pressure be low! CE Grim MD Clinical Professor of Internal Medicine Professor of Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertenision Quote Link to comment Share on other sites More sharing options...
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