From the Guidelines
Hyperreninemia is most commonly caused by renal artery stenosis, volume depletion, certain medications, and renin-secreting tumors, and its management involves treating the underlying condition rather than the elevated renin levels themselves. The causes of hyperreninemia can be multifactorial, and identifying the primary cause is crucial for effective management. According to the study by 1, certain medications such as beta-blockers, NSAIDs, and renin-angiotensin-aldosterone system inhibitors can lead to hyperkalaemia, which may be associated with hyperreninemia.
Common Causes of Hyperreninemia
- Renal artery stenosis: This condition can lead to increased renin production, and treatment may involve antihypertensive medications like ACE inhibitors or angiotensin receptor blockers, as well as revascularization procedures 1.
- Volume depletion: This can cause a decrease in blood volume, leading to increased renin production, and treatment involves intravenous fluids and salt replacement.
- Certain medications: Medications such as diuretics, beta-blockers, and NSAIDs can cause hyperreninemia, and adjusting or discontinuing the offending drug may be necessary.
- Renin-secreting tumors: These rare tumors can produce excess renin, leading to hyperreninemia, and surgical removal is the definitive treatment.
Management of Hyperreninemia
The management of hyperreninemia involves treating the underlying cause rather than the elevated renin levels themselves. This may involve:
- Antihypertensive medications: ACE inhibitors or angiotensin receptor blockers may be used to treat renal artery stenosis, but should be used cautiously in patients with bilateral stenosis.
- Revascularization procedures: Restoring main renal artery patency with endovascular stenting may be necessary to reduce arterial blood pressure.
- Intravenous fluids and salt replacement: These may be used to treat volume depletion.
- Surgical removal: This is the definitive treatment for renin-secreting tumors. Regular monitoring of blood pressure, kidney function, and electrolytes is essential during treatment, as hyperreninemia itself is not a disease but rather a laboratory finding that indicates an underlying physiological disturbance in the body's blood pressure regulation system.
From the FDA Drug Label
Renin is secreted by the kidney in response to decreases in blood volume and renal perfusion. The causes of hyperreninemia (elevated renin levels) include:
- Decreases in blood volume
- Decreases in renal perfusion These conditions trigger the secretion of renin by the kidney, leading to increased renin levels 2.
From the Research
Causes of Hyperreninemia
The causes of hyperreninemia, or elevated renin levels, can be attributed to various factors. Some of the possible causes include:
- Reninoma, a functional tumor of afferent arteriolar juxtaglomerular cells that secretes the enzyme renin, leading to hyperactivation of the renin-angiotensin-aldosterone system 3
- Renovascular hypertension, which can be caused by renal artery stenosis or other conditions affecting the renal arteries 4, 5, 6
- Fibromuscular dysplasia, a condition that can cause intrarenal artery stenosis and lead to excessive renin secretion 6
- Accessory renal artery, which can be a possible cause of renovascular hypertension in children and adolescents, even in the absence of hyperreninemia 5
Secondary Causes of Hyperreninemia
Secondary causes of hyperreninemia can also occur, including:
- Malignant hypertension, a condition characterized by severe hypertension and multi-organ ischemic complications 4
- Primary aldosteronism, a condition that can lead to hyperaldosteronism and hypokalemia 3
- Other conditions that affect the renin-angiotensin-aldosterone system, such as sodium-volume overload or hereditary conditions 7