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Test Code Epic LAB532 Renin Activity, Plasma

Additional Codes

SQ code RENINM

Mayo code PRA

Reporting Name

Renin Activity, P

Specimen Type

Plasma EDTA

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Investigation of primary aldosteronism (eg, adrenal adenoma/carcinoma and adrenal cortical hyperplasia) and secondary aldosteronism (renovascular disease, salt depletion, potassium loading, cardiac failure with ascites, pregnancy, Bartter syndrome)

 

This test is not useful for determination of plasma renin concentration.


Specimen Required


Patient Preparation: For 4 to 6 weeks before specimen collection, spironolactone (Aldactone) should be discontinued, as plasma renin activity cannot be interpreted if the patient is being treated with spironolactone.

Collection Container/Tube: Chilled, lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 0.8 mL

Collection Instructions:

1. Draw blood in a chilled syringe from a patient in a seated position; place specimen in a chilled, 3-mL lavender-top (EDTA) tube and mix well. Alternatively, draw blood directly in a chilled, EDTA tube.

2. Immediately place EDTA tube into an ice-water bath until thoroughly cooled.

3. Immediately centrifuge using a refrigerated centrifuge and aliquot plasma into a plastic vial.

Note: If a refrigerated centrifuge is unavailable, chill the centrifuge carriers before use. Centrifuge specimen for 5 minutes or less, then promptly aliquot plasma into a plastic vial.

4. Immediately freeze plasma.


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma EDTA Frozen 14 days

Special Instructions

Reference Values

0-2 years: 4.6 ng/mL/h (mean)* Range: 1.4-7.8 ng/mL/h

3-5 years: 2.5 ng/mL/h (mean)* Range: 1.5-3.5 ng/mL/h

6-8 years: 1.4 ng/mL/h (mean)* Range: 0.8-2.0 ng/mL/h

9-11 years: 1.9 ng/mL/h (mean)* Range: 0.9-2.9 ng/mL/h

12-17 years: 1.8 ng/mL/h (mean)* Range: 1.2-2.4 ng/mL/h

Mean data not standardized as to time of day or diet. Infants were supine, children sitting.

*Stalker HP, Holland NH, Kotchen JM, Kotchen TA. Plasma renin activity in healthy children. J Pediatr. 1976;89(2):256-258

 

Na-depleted, upright (peripheral vein specimen)

18-39 years: 10.8 ng/mL/h (mean)

2.9-24.0 ng/mL/h (range)

≥40 years: 5.9 ng/mL/h (mean)

2.9-10.8 ng/mL/h (range)

 

Na-replete, upright (peripheral vein specimen)

18-39 years: 1.9 ng/mL/h (mean)

≤0.6-4.3 ng/mL/hour (range)

≥40 years: 1.0 ng/mL/h (mean)

≤0.6-3.0 ng/mL/h (range)

Day(s) Performed

Monday through Friday, Sunday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

84244

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PRA Renin Activity, P 2915-7

 

Result ID Test Result Name Result LOINC Value
8060 Renin Activity, P 2915-7

Reject Due To

Gross hemolysis Reject
Gross lipemia OK
Gross icterus OK

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

Portions of this test are covered by patents held by Quest Diagnostics

Method Description

The renin in plasma is allowed to act on the plasma's endogenous substrate, angiotensinogen, producing angiotensin I. This is measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). Renin activity is expressed in ng of angiotensin produced per mL of plasma per hour of incubation.

 

The primary metabolite of renin activity, angiotensin I, is cleaved by converting enzyme to angiotensin II. By inhibiting the action of converting enzyme and the angiotensinases with EDTA, dimercaprol (BAL) and 8-hydroxyquinoline, it is possible to indirectly measure the activity of renin during a controlled incubation by measuring the concentration (in ng) of angiotensin I that is generated.

 

Plasma is mixed with generation buffer in two microtiter plates, which are then incubated: one at 0° C and the other at 37° C for 1 hour. During incubation, internal standard (IS) and reagent are added to the 0° C mixture. After incubation, IS and reagent are added to the 37° C mixture. The plates are then centrifuged, and the supernatant layers transferred to clean microtiter plates. The reagents are evaporated under nitrogen, reconstituted, and the angiotensin I analyzed by LC-MS/MS.(Bruton J, Singh RJ, Grebe SK, Ladwig P, Barnidge D. Sensitive and rapid determination of angiotensin I utilizing on-line extraction and LC-MS/MS [Abstract D-64] Clin Chem. 2007;53(Suppl):A180–A181)

Report Available

2 to 5 days

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Cardiovascular Test Request (T724)