I have low renin and aldosterone. What does this mean?

[Derek1987]

After getting blood work done twice from the endo doc, the results say i have low renin and low aldosterone. FYI i have been diagnosed with hyper pots. What could this mean? I dont know when ill hear from the doctor. I just got a notification from the doctor with brief commentary that doesnt explain too much on his app.  He said it could be from midodrine but i seldom take it because my blood pressure is already too high. I take it occasionally when my BP dips too low. Its probably been a couple of months since ive taken any.  I responded back and told him that. Thoughts?

[Pistol]

Dear @Derek1987 I have found the following article that mentions low renin/ low aldoaterone in detail. Unfortunately it is in medical lingo so I find this info interesting ( from this web site:  https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2265.2007.02898.x

Low‐renin/low‐aldosterone hypertension can be acquired or genetically determined (Fig. 1). Several conditions should be considered in the differential diagnosis of acquired forms. First, a very generous dietary sodium intake may underlie this functional phenotype in essential hypertensive patients.

This means that a high sodium diet CAN cause it.  

 Second, low‐renin coupled with low‐aldosterone plasma levels may have pharmacological causes. Drugs reducing the renin‐angiotensin‐aldosterone system (RAAS) activation include beta‐blockers and centrally acting agents such as clonidine and alpha‐methyldopa.22, 27 Also, nonsteroidal anti‐inflammatory drugs (NSAIDs) and newer COX‐2 inhibitors inhibit the RAAS by suppressing intrarenal prostaglandin and renin secretion directly and by reducing sodium excretion, thus favouring volume expansion and aggravating hypertension.

These drugs are commonly used in POTS and if you are taking them they may be a cause - please discuss with your physician. 

Third, a low‐renin/low‐aldosterone status may derive from a marked reduction in nephron number and function. These conditions include diabetic nephropathy, chronic glomerulonephritis, congenital solitary kidney, unilateral nephrectomy or ageing. 

If you are diagnosed with any of these conditions it may be a cause. - Here is another related cause:

Liddle's syndrome is inherited as an autosomal dominant condition and is characterized by hypokalaemia associated with low‐renin and low‐aldosterone levels.  Hypertension is often present in early childhood or at a young age and families show a high frequency of cerebrovascular events. 

 

A perhaps easier to understand article from webMD can be found here: 

https://www.webmd.com/hypertension-high-blood-pressure/renin-test#:~:text=High renin with normal aldosterone may show that,sign that there’s a problem with your kidneys.

[POTSius]

It seems some POTS patients get this

See this article

https://www.heartrhythmjournal.com/article/S1547-5271(10)01204-X/fulltext

a select quote from it:

"POTS patients trended to lower PRA levels than did controls (0.9 ± 0.1 ng/mL/h vs 1.6 ± 0.5 ng/mL/h, P = .268) and lower aldosterone levels (4.6 ± 0.8 pg/mL vs 10.0 ± 3.0 pg/mL, P = .111)"

PRA = plasma renin activity

I think this is specifically for a certain subset of POTS patients?

I recall recent research looking into the renin aldosterone abnormalities in POTS  as being an autoimmune thing

[Derek1987]

9 hours ago, Pistol said:

Dear @Derek1987 I have found the following article that mentions low renin/ low aldoaterone in detail. Unfortunately it is in medical lingo so I find this info interesting ( from this web site:  https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2265.2007.02898.x

Low‐renin/low‐aldosterone hypertension can be acquired or genetically determined (Fig. 1). Several conditions should be considered in the differential diagnosis of acquired forms. First, a very generous dietary sodium intake may underlie this functional phenotype in essential hypertensive patients.

This means that a high sodium diet CAN cause it.  

 Second, low‐renin coupled with low‐aldosterone plasma levels may have pharmacological causes. Drugs reducing the renin‐angiotensin‐aldosterone system (RAAS) activation include beta‐blockers and centrally acting agents such as clonidine and alpha‐methyldopa.22, 27 Also, nonsteroidal anti‐inflammatory drugs (NSAIDs) and newer COX‐2 inhibitors inhibit the RAAS by suppressing intrarenal prostaglandin and renin secretion directly and by reducing sodium excretion, thus favouring volume expansion and aggravating hypertension.

These drugs are commonly used in POTS and if you are taking them they may be a cause - please discuss with your physician. 

Third, a low‐renin/low‐aldosterone status may derive from a marked reduction in nephron number and function. These conditions include diabetic nephropathy, chronic glomerulonephritis, congenital solitary kidney, unilateral nephrectomy or ageing. 

If you are diagnosed with any of these conditions it may be a cause. - Here is another related cause:

Liddle's syndrome is inherited as an autosomal dominant condition and is characterized by hypokalaemia associated with low‐renin and low‐aldosterone levels.  Hypertension is often present in early childhood or at a young age and families show a high frequency of cerebrovascular events. 

 

A perhaps easier to understand article from webMD can be found here: 

https://www.webmd.com/hypertension-high-blood-pressure/renin-test#:~:text=High renin with normal aldosterone may show that,sign that there’s a problem with your kidneys.

The endo doc just messaged me on the app saying.

"Are you taking the coreg? That could lower the renin as well.

Otherwise low renin and aldosterone can be a sign of very rare issues such as congenital adrenal hyperplasia, Cushings disease, many others. We can test for these though your symptoms don't fit well

Question - have you ever taken fludrocortisone in the past ?"

 

I responded with yes i take coreg twice a day and have never taken fludrocortisone. 

 

so...yeah.

[p8d]

I was told that I needed to stop alpha and betas to have this tested again. Alpha first and slowly then beta also slowly. I did that last year to switch betas and it was difficult to say the least. Apparently you always should stop alphas before betas. I believe that you need to be off both for a week or more for this test.

[haugr]

An ACE2 deficiency can lead to low renin and is a known cause of hyper pots.  The deficient ACE2 ends up leading to a high amount of angiotensin II in the blood stream, which ultimately causes the kidneys to lower their renin production.

[haugr]

@Derek1987 Have you had your testosterone levels checked by chance?

[Derek1987]

5 hours ago, haugr said:

@Derek1987 Have you had your testosterone levels checked by chance?

I did in late 2018. It was fine then. 

[E pots]

On 4/27/2021 at 7:31 AM, ramakentesh said:

Yes the adrenalin surges. Hadnt had them for a decade until this recent flare when they went bezerk. Four nights of 8 hours solid. Not the best time ive had. 

Beta blockers didnt really help. Valarian out of desperation and taurine maybe helped a little.

 

On 7/10/2020 at 1:07 PM, haugr said:

An ACE2 deficiency can lead to low renin and is a known cause of hyper pots.  The deficient ACE2 ends up leading to a high amount of angiotensin II in the blood stream, which ultimately causes the kidneys to lower their renin production.

Can is resolve with decreased sodium intake?