Hypoaldosteronism classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Hypoaldosteronism may be classified into two categories depending on the level of plasma renin and depending on the level of aldosterone into hyporeninemic hypoaldosteronism or hyperreninemic hypoaldosteronism, and aldosterone deficiency or aldosterone resistance.

Classification

Hypoaldosteronism may be classified into two categories depending on the level of plasma renin and depending on the level of aldosterone into hyporeninemic hypoaldosteronism or hyperreninemic hypoaldosteronism, and aldosterone deficiency or aldosterone resistance.

Based on the level of plasma renin

Hypoaldosteronism can be classified on the level of plasma renin activity. Renin deficiency is the most common cause of hypoaldosteronism. Juxtaglomerular apparatus in the kidneys produce the hormone renin in response to decreased plasma sodium concentration or decreased renal perfusion pressure. Any condition that affects the kidney may lead to decreased levels of the hormone renin. Conditions affecting the adrenal cortex leads to increased levels of renin and decreased levels of aldosterone.

Hypoaldosteronism

Hyporeninemic Hypoaldosteronism

Hyperreninemic Hypoaldosteronism

•Renal insufficiency •Diabetic nephropathy •Sickle cell disease

•Addison's disease • Any severe illness such as malignancy or sepsis

Based on the level of aldosterone

Hypoaldosteronism can be classified on the level of aldosterone. Deficiency in aldosterone is seen with disorders of kidney or adrenal gland and drugs inhibiting aldosterone synthesis. Patients with normal to increased levels of aldosterone have end organ resistance to the action of aldosterone. The condition includes mineralocorticoid receptor defects and drugs inhibiting action of aldosterone.

Hypoaldosteronism

Aldosterone deficiency

Aldosterone resistance

•Renal insufficiency •Adrenal insufficiency • Diabetic nephropathy •Sickle cell disease •Critical illness •Congenital isolated hypoaldosteronism • Drugs such as ACEi, ARBs and Heparin

• Pseudohypoaldosteronism type 1 • Aldosterone antagonists • Epithelial sodium channel blockers • Calcineurin inhibitors