Performance of Plasma Renin Assays in Guiding Mineralocorticoid Dosing in Children With Adrenal Insufficiency
Authors' conclusion
Our investigation found PRA performed superiorly to PRC for assessing MC replacement in paediatric patients, based on supporting biochemical and clinical parameters. Our results indicated that use of PRA may help to standardise practice when assessing MC replacement; this is likely to have patient benefit through improved blood-pressure and electrolyte control.
Study context
- Population
- Patients <18 years old with samples requested for plasma renin concentration (PRC); salt-wasting adrenal insufficiency (AI) on mineralocorticoid (MC) replacement
- Participants
- 129 patients
- Exposure
- Plasma renin activity (PRA) vs plasma renin concentration (PRC) for guiding MC dosing
- Outcome
- Agreement between PRC and PRA interpretation (low, normal, high by reference ranges)
Methodological detailsretrospective clinical review, randomly selected samples
- Retrospective clinical review
- Randomly selected samples
Main finding
As reported in the abstract
Samples with agreement between PRC and PRA interpretation
96
74%
Samples with disagreement
33
Observational data: associations, not effects.
Further findings
Clinical decision on MC replacement among discordant adrenal clinic samples
- Discordant samples from adrenal clinic patients
- 17 of 33
- Would have a different MC replacement decision based on PRA vs PRC
- 8
- In each of these, PRA-based MC dose adjustment strongly supported by serum sodium and blood pressure centiles
- In one instance PRC had been deliberately ignored by clinicians; PRA provided reassurance that MC replacement had been correctly assessed
Original publication
Performance of Plasma Renin Assays in Guiding Mineralocorticoid Dosing in Children With Adrenal Insufficiency. Clin Endocrinol (Oxf). Published 18 December 2025. doi:10.
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