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Hypertension with high renin levels - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3621 Questions
User :   I'm trying to understand what my lab results mean
Aldosterone Range: less than 21.............mine 5.9
Cortisol Range: 8.0-28.0...................mine 9.1 & 20.7 (never consistant)
Renin Activity Range: 2.9-24..............mine 1.8
ACTH,Plasma Range: 5-27..................mine 34

I was diagnosed with hypertension 5 years ago (at age 29), bp was 230/146. Very hard to control until started taking Tekturna, a renin inhibitor. I still do not feel well and having such a hard time finding a doctor to listen to me. I know it has something to do with the renin level and I think other hormones that may be affected by the renin. Do these lab results look normal??
User :   Hi
User :   hi
User :  
May I know your age and gender?
User :   female, just turned 35
User :   6 ft tall, 157 lbs, no signs of hypertension anywhere in the family
User :  
Since when have you been diagnosed to have hypertension?
User :   I was diagnosed in 2005
User :   Your reports are slightly abnormal.
User :   I shall explain.

User :  
Renin is an hormone that is secreted at the kidneys which are converted to angiotension by the activity of an enzyme.
User :  
A slightly higher range of renin may indicate an abnormality in this enzyme conversion.
User :  
This should probably the cause for your hypertension.
User :   I find it odd considering I'm on the renin inhibitor while they did these labs. I also find it odd they haven't tested me free of all the meds to get a clear reading???
User :   It is ideal that these test are done after reducing these drugs..
User :  
However if the BP is not controlled then these tests may be performed with the medications too.
User :  
You may need further evaluations.
User :  
Evaluations to know about the kidney functions well.
User :  
That can include a few more blood tests with or without a renal doppler scans.
User :   Renal doppler showed multiple cysts but no renal stenosis
User :   Have your undergone kidney function tests?
User :   I don't believe so, that doesn't sound familiar
User :   Renin hormone is secreted by the kidney, the juxtaglomerular cells.
User :  
Hence the kidney functions may be needed.
User :   how is this done?
User :   You may also need serum potassium levels along with these tests.
User :   May I know your location?
User :   Iowa
User :  
Kidney function test include serum creatinine, BUN, 24 hour urine protein, albumin, calcium/microproteins.
User :  
These are blood tests and urine tests.
User :   It seems you have moved out of the chat window. Please log in back if you have medical queries.
User :   Yes, I've done those tests
User :   What I don't understand is why the aldosterone, cortisol, renin levels never come back with consistant numbers when all are done at the same time under same conditions
Doctor :   ok
User :   They are testing me also every 3 months for pheochromocytoma
Doctor :  
may I ask whether the cyst that was detected was solid in consistency or fluid filed cyst or a mixed cyst?
User :   I had a very adverse reaction while on the beta blockers which apparently can be a sign of a pheochromocytoma???
Doctor :   ok
User :   Um, they never told me actually
Doctor :  
high cortisol levels and aldosterone levels could point towards a pheochromocytoma.
Doctor :   do you have the copy of the ultrasound report?
User :   I just got it but its on a CD which I don't have the software to read it
User :   I'm taking it to my primary, it's from Mayo Clinic-Rochester, MN
Doctor :  
User :   Is renin the most common cause of essential hypertension?
Doctor :  
what i would suggest now is to do a renin levels test without being on the renin inhibitors, and complete your workup for the pheochromocytoma
User :   OK, that was my intent. It just bothers me that the doctor didn't suggest this??
Doctor :   high renin levels indictae essential hypertension
Doctor :  
and the high renin levels combined with low potassium evls and abnormal urine analysis tests
Doctor :  
with evidence of solid cysts in lidneys
Doctor :  
could indicate 3 possibilities
Doctor :  
1) reninoma, 2) Wilm's tumor, 3) renal cel carcinma
Doctor :  
with the high cortisol and aldosterone levels any possibilities of pheochromocytoma should be looked for
Doctor :  
and the confirmative test to see what is responsible for the renin to be increased
Doctor :  
is to do a biopsy and histopathological examination of the sample from the cyst/tumor
Doctor :  
which will show the pattern of the abnormal cells and confirm the origin of them
Doctor :  
telling what is causing the renin to be increased
Doctor :  
have you followed what I have said?
User :   Yes.
Doctor :  
Is there any thing you would like to ask me?
User :   I don't believe so. Am I able to link to you again if I would have questions down the road?
Doctor :  
yes surely, you can discuss your queries with me.
Doctor :  
I am Dr. XXXXXXXX here
Doctor :  
you can log in and ask for me
User :   Great. May I ask where you are located?
Doctor :  
I am located in Bangalore, India currently.
Doctor :  
and once the tests are completed for you
Doctor :  
you can obtain a copy of them
Doctor :  
and send across to me at
Doctor :  
Doctor :  
where I can go through them and have our panel specialists also to look at them and sugest what needs to be done next.
Doctor :  
have you followed?
Doctor :  
is there anything else you would like to ask me?
User :   Yes I have and appreciate your help
Doctor :  
Please fill the feedback form say done when done.
User :   I will do that. Thank you.
Doctor :   Thanks for consulting me. Bye for now. Please chat with our doctors 24/7 for medical queries. Please refer your friends to our service.
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