Renin

Alternative names
Plasma renin activity; Random plasma renin; PRA

Definition
The renin test measures the amount of renin in the blood.

How the test is performed

Adult or child:
Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any bleeding.

How to prepare for the test
The health care provider may advise you to withhold drugs that can affect the test (see “Special considerations”).

Consume a normal, balanced diet with low-sodium content (about 3 gm/day) for 3 days before the test.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

• Infant test or procedure preparation (birth to 1 year)
  
• Toddler test or procedure preparation (1 to 3 years)
  
• Preschooler test or procedure preparation (3 to 6 years)
  
• School age test or procedure preparation (6 to 12 years)
  
• Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

Plasma renin activity (PRA) is measured as part of the diagnosis and treatment of Hypertension.

Patients with primary hyperaldosteronism will have an increased aldosterone (for more information see the aldosterone test) production associated with a decreased PRA. Patients with secondary hyperaldosteronism (that is, caused by Kidney disease or renal vascular disease) will have increased plasma levels of renin and aldosterone.

Patients may also have renin and aldosterone levels checked in essential Hypertension to evaluate if patients are salt-sensitive. This will cause a low renin with normal aldosterone levels, and this helps to guide the physician in choosing the correct medication for these patients. Salt-sensitive patients with low renin hypertension respond well to diuretic medications.

Renin is an enzyme released by specialized cells of the kidney into the blood. It is in response to sodium depletion or low blood volume. Renin converts angiotensinogen (a protein released into the blood by the liver) to angiotensin I.

Angiotensin I is converted to angiotensin II by an enzyme in the veins of the lungs. Angiotensin II acts on the adrenal cortex to stimulate the release of aldosterone. Aldosterone acts on the distal tubules of the kidneys to decrease the loss of sodium ions and secondarily fluid. This has the effect of increasing blood pressure. In addition, angiotensin causes constriction of small blood vessels, which also increases blood pressure.

Normal Values

Normal values range from 1.9 to 3.7 ng/ml/hour. Normal value ranges may vary slightly among different laboratories.

Note: ng/ml/hour = nanograms per milliliter per hour

What abnormal results mean

Abnormal results are indicated as follows:

Greater-than-normal levels may indicate:

• Addison’s disease
  
• Cirrhosis
  
• Essential hypertension
  
• Hemorrhage (bleeding)
  
• Hypokalemia
  
• Malignant hypertension
  
• Renin-producing renal tumors
  
• Renovascular hypertension

• Salt-retaining steroid therapy
  
• ADH therapy
  
• Salt-sensitive essential hypertension

What the risks are

• Excessive bleeding
  
• Fainting or feeling lightheaded
  
• Hematoma (blood accumulating under the skin)
  
• Infection (a slight risk any time the skin is broken)
  
• Multiple punctures to locate veins

Renin measurements are affected by pregnancy, salt intake, time of day, and a standing vs. prone position.

Drugs that can affect renin measurements include antihypertensives, diuretics, estrogens, oral contraceptives, and vasodilators.

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

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