Comparison of 24-h Urinary Aldosterone Level and Random Urinary Aldosterone-to-Creatinine Ratio in the Diagnosis of Primary Aldosteronism

Che Hsiung Wu, Ya Wen Yang, Ya Hui Hu, Yao Chou Tsai, Ko Lin Kuo, Yen Hung Lin, Szu Chun Hung, Vin Cent Wu, Kwan Dun Wu, Yi Luwn Ho, Hung Wei Chang, Lian Yu Lin, Fu Chang Hu, Kao Lang Liu, Shuo Meng Wang, Kuo How Huang, Yung Ming Chen, Chin Chi Kuo, Chin Chen Chang, Shih Chieh ChuehChing Chu Lu, Shih Cheng Liao, Ruoh Fang Yen

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12 Citations (Scopus)

Abstract

Background:Historically, urinary aldosterone level measurement was a commonly employed confirmatory test to detect primary aldosteronism (PA). However, 24-h urine collection is inconvenient and cumbersome. We hypothesized that random urinary aldosterone measurements with correction for creatinine concentration might be comparable to 24-h urinary aldosterone levels (Uald-24 h) in the diagnosis of PA.Methods:The non-concurrent prospective study was conducted between June 2006 and March 2008 in patients admitted for confirmation of aldosteronism by salt loading test. A 24-h urine sample, which was collected during hospitalization on the day before saline infusion testing after restoration of serum hypokalemia, was collected from all subjects. Moreover, participants were asked to collect a first bladder voiding random urine sample during clinic visits. Uald-24 h and the random urinary aldosterone-to-creatinine ratio (UACR) were calculated accordingly.Results:A total of 102 PA patients (71 patients diagnosed of aldosterone-producing adenoma, 31 with idiopathic hyperaldosteronism) and 65 patients with EH were enrolled. The receiver operating characteristic curve showed comparable areas under the curves of UACR and Uald-24 h. The Bland-Altman plot showed mean bias but no obvious heteroscedasticity between the two tests. When using random UACR >3.0 ng/mg creatinine as the cutoff value, we obtained a specificity of 90.6% to confirm PA from essential hypertension.Conclusions:Our study reinforce that the diagnostic accuracy of random UACR was comparable to that of Uald-24 h in PA patients. With the quickness and simplicity of the UACR method and its equivalence to Uald-24 h, this assay could be a good alternative diagnostic tool for PA confirmation.

Original languageEnglish
Article numbere67417
JournalPLoS ONE
Volume8
Issue number6
DOIs
Publication statusPublished - Jun 28 2013
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Wu, C. H., Yang, Y. W., Hu, Y. H., Tsai, Y. C., Kuo, K. L., Lin, Y. H., Hung, S. C., Wu, V. C., Wu, K. D., Ho, Y. L., Chang, H. W., Lin, L. Y., Hu, F. C., Liu, K. L., Wang, S. M., Huang, K. H., Chen, Y. M., Kuo, C. C., Chang, C. C., ... Yen, R. F. (2013). Comparison of 24-h Urinary Aldosterone Level and Random Urinary Aldosterone-to-Creatinine Ratio in the Diagnosis of Primary Aldosteronism. PLoS ONE, 8(6), [e67417]. https://doi.org/10.1371/journal.pone.0067417