From the Guidelines
Low renin states are commonly associated with primary aldosteronism, Liddle syndrome, chronic kidney disease, excessive sodium intake, advancing age, and certain medications like NSAIDs, beta-blockers, and mineralocorticoids. Several physiologic conditions are associated with low renin levels, including:
- Primary aldosteronism (Conn's syndrome), which is characterized by autonomous aldosterone production that suppresses renin through negative feedback 1
- Liddle syndrome, a genetic disorder causing excessive sodium reabsorption in the kidneys, leading to volume expansion and subsequent renin suppression
- Chronic kidney disease, which often results in low renin as functioning kidney tissue decreases
- Excessive sodium intake or volume expansion from any cause, which suppresses renin production as the body attempts to increase sodium excretion
- Advancing age, which is associated with declining renin levels due to age-related changes in kidney function
- Certain medications like NSAIDs, beta-blockers, and mineralocorticoids, which can reduce renin production Other conditions with low renin include Gordon syndrome (familial hyperkalemic hypertension), chronic steroid use, and some forms of congenital adrenal hyperplasia 1. Understanding these low renin states is important for properly diagnosing and treating hypertension, as treatment approaches differ significantly between low-renin and high-renin hypertensive conditions, and a high aldosterone-to-renin ratio is suggestive of primary aldosteronism, particularly in a patient taking an ACE inhibitor or ARB 1.
From the Research
Physiologic States with Low Renin
- Liddle's syndrome: a rare autosomal dominant disease characterized by early-onset hypertension, hypokalemia, and hypoaldosteronism, with low renin and aldosterone levels 2, 3, 4, 5, 6
- Hyporeninemic hypoaldosteronism: a disorder characterized by low renin and aldosterone levels, often associated with hypertension and hypokalemia 3
- Atypical Liddle syndrome: a variant of Liddle's syndrome that can present with normal aldosterone levels, making diagnosis more challenging 4
- Salt-sensitive hypertension: a condition where blood pressure is sensitive to salt intake, which may be related to the sodium channel defect found in Liddle's syndrome 5
Characteristics of Low Renin States
- Hypertension: high blood pressure is a common feature of low renin states, including Liddle's syndrome and hyporeninemic hypoaldosteronism 2, 3, 4, 5, 6
- Hypokalemia: low potassium levels are often found in low renin states, due to excessive potassium wasting in the urine 2, 3, 4, 5, 6
- Low aldosterone levels: aldosterone is often suppressed in low renin states, including Liddle's syndrome and hyporeninemic hypoaldosteronism 2, 3, 4, 5, 6