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Epic Code LAB1230661 Currently Unavailable: Aldosterone Direct Renin and Ratio

Important Note

4/2/2024 - This test is currently unavailable due to reagent shortage. Please do not order this test. We recommend if testing is needed to order

  • LAB1230656 Aldosterone, which will be sent out to Mayo Clinic Laboratories and
  • LAB1230657 Direct Renin which will be performed at Corewell Health Reference Laboratory West 


Interface Order Alias


Quick Collect


Collection Instructions

Specimen Collection: Blood


Container(s): EDTA Lavender Tube

Preferred Volume to Collect: 3 mL

Minimum Volume to Collect: 2 mL

Neonate Volume to Collect: 2 mL

Capillary collect ok? No

Microtainer acceptable: No


Suggested Collection Instructions:

  1. Collect midmorning after the patient has been sitting, standing, or walking for at least 2 hours.
  2. Allow patient to sit 5-15 minutes prior to the draw.
  3. Avoid fist clenching and wait at least 5 seconds after the tourniquet release (if used) to insert the needle.
  4. Collect slowly with a syringe and needle. 
  5. Preferably do not use a Vacutainer to minimize the risk of spuriously raising potassium.
  6. Collect blood carefully, avoiding stasis and hemolysis.
  7. Invert tube gently 8 to 10 times.
  8. Maintain sample in Lavender EDTA at room temperature (ambient), never refrigerate.
  9. Specimen should be processed (aliquoted) within 30 minutes. See Processing Instructions below. Aliquot should be frozen.


Processing Instructions (Laboratory, Outpatient or Off-site collection)

  • Processed Specimen: Plasma
  • Centrifuge/Spin: Yes
  • Aliquot: Yes
  • Processed Minimum Volume: 1 mL
  • Processing Instructions:

    • Centrifuge after collection.
    • Reject if plasma is hemolyzed.
    • Within 30 minutes aliquot plasma into a plastic transport tube and freeze immediately.
  • Transport Temperature: Frozen

Rejection Criteria

  • Specimen not centrifuged within 30 minutes after collection.
  • Plasma hemolyzed.
  • Centrifuged plasma not meeting specimen stability requirements.

Specimen Stability


  • Ambient: Not Acceptable
  • Refrigerate: Not Acceptable
  • Frozen: 28 days
  • Laboratory Retention: 28 days

Test Frequency

Twice per week, Monday and Thursday.. Average turn around time is 1-5 days

Reference Range

Aldosterone male and female: <31.0 ng/dL

Direct Renin male and female: < 45.7 pg/mL

Aldosteron/Direct Renin Ratio male and female: 0.1 to 3.7

Performing Department


Performing Department Laboratory Location

Corewell Health Reference Laboratory, Grand Rapids, MI




84244, 82088

CDM Code

3008424401, 3008208803

Epic Test ID



Result name: 30894-0

Additional Information

Suggested Steps to Prepare Patient for Aldosterone-Direct Renin Ratio (ARR) Testing a:

  1. Attempt to correct hypokalemia.
  2. A plasma concentration of [K+] 4.0 mmol/L is the goal for supplementation.
  3. Encourage patient to liberalize (rather than restrict) sodium intake.
  4. Withdraw agents that markedly affect the ARR for at least 4 weeks.
    1. Spironolactone, eplerenone, amiloride, and triamterene
    2. Potassium-wasting diuretics
    3. Products derived from licorice root (eg, licorice, chewing tobacco)
  5. If the results of ARR after discontinuation of the above agents are not diagnostic, and if hypertension can be controlled with relatively noninterfering medications (see Medication table in Lab Catalog), withdraw other medications that may affect the ARR for at least 2 weeks and retest
  1. β-adrenergic blockers, central α2-agonists (eg, clonidine, α-methyldopa), and nonsteroidal anti-inflammatory drugs
  2. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and dihydropyridine calcium channel antagonists
  1. If necessary to maintain hypertension control, commence other antihypertensive medications that have lesser effects on the ARR.  See Medication table in Lab Catalog.
  2. Establish oral contraceptive (OC) and hormone replacement therapy (HRT) status prior to testing because estrogen-containing medications may lower the direct renin concentration (DRC) and cause false-positive ARR when DRC is measured.  Do not withdraw OC unless confident of alternative effective contraception.  Recommend ordering the test “Direct Renin, Blood Level” (LAB1230657) for these patients.

a  Adapted from Funder JW et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Guideline. J Clin Endocrinol Metab, 2016 May, 101(5): 1889-916.

Reviewed Date