Urinary Aldosterone Concentration: Its Value in Primary Aldosteronism Screening and Comparison of a LC-MS/MS Assay and a CLIA Assay for Its Determination
- VernacularTitle:尿醛固酮浓度在原发性醛固酮增多症中的筛查价值及质谱法和化学发光法检测的比较
- Author:
Jing FAN
1
;
Xiao-yun ZHANG
1
;
Qi-ling FENG
1
;
Ju-ying TANG
1
;
Shao-ling ZHANG
1
;
Feng LI
1
;
Ying GUO
1
;
Li YAN
1
Author Information
1. Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- Publication Type:Journal Article
- Keywords:
urinary aldosterone concentration(UAC);
primary aldosteronism(PA);
liquid chromatography tandem mass spectrometry(LC-MS/MS);
chemiluminescence immunosorbent assay(CLIA)
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2020;41(4):563-571
- CountryChina
- Language:Chinese
-
Abstract:
【Objective】 To explore the clinical value of urinary aldosterone concentration(UAC) in primary aldosteronism(PA) screening and to evaluate the consistency of the two methods, liquid chromatography tandem mass spectrometry(LC-MS/MS) and chemiluminescence immunosorbent assay(CLIA), for determining UAC. 【Methods】 Among the 133 patients with suspected PA enrolled from October 2018 to August 2019, 55 were diagnosed with PA(30 with aldosteroneproducing adenoma and 25 with bilateral idiopathic hyperplasia) and 78 with essential hypertension(EH). Parallel determination of UAC was done with LC-MS/MS and CLIA assays on all subjects, then we compared the two methods and evaluated their correlation and consistency. Reciever operating characteristic(ROC) analysis was applied to assess the diagnostic accuracies, area under the curve(AUC) and cutoff values of UAC, plasma aldosterone concentration(PAC), random aldosterone to renin ratio(ARR) and urine aldosterone to renin ratio(UARR). Furthermore, ROC analysis of high urine sodium subgroup(urine sodium≥130 mmol/24h) was performed to evaluate the impact of sodium intake on PA screening. 【Results】 ①UACCLIA and UACLC-MS/MS were positively correlated(r=0.69, P < 0.001). Bland-Altman analysis showed poor consistency between CLIA and LC-MS/MS. ②The diagnostic efficiency of UAC and PAC in PA screening was equivalent (P > 0.05), while ARR was more efficient than UAC and PAC(P < 0.0001). AUC of UACCLIA, UACLC-MS/MS, PAC and ARR was 0.739, 0.659, 0.723, 0.943, respectively. The cutoff values for them were 5.1 μg/24 h, 11.6 μg/24 h, 27.6 ng/dL and 23.2 ng·dL-1(/ μg·L-1·h-1), respectively. ③Both UARRCLIA and UARRLC-MS/MS performed as well as ARR in PA screening. AUC of UARRCLIA was 0.924 at the cutoff value of 1.75 μg·24h-1(/ μg·L-1·h-1). While AUC of UARRLC-MS/MS was 0.906 at the cutoff value of 4.63 μg·24h-1(/ μg·L-1·h-1). AUC of UACLC-MS/MS in high urine sodium subgroup was 0.708 at the cutoff of 14.9 μg/ 24 h. ④The diagnostic efficiency of UAC made no difference after sodium intake increased to 130 mmol/24 h or higher. 【Conclusion】 UAC alone is of little clinical value compared to ARR in PA screening and can serve as a supplementary indicator currently. But UARR, a combintion of UAC and plasma renin activity(PRA), is as valuable as ARR for screening PA. The optimal cutoff values of UACLC-MS/MS and UACCLIA are 11.6 μg/24 h, 5.1 μg/24 h, respectively. The optimal cutoff values of UARRLC-MS/MS and UARRCLIA are 4.63 μg·24 h-1/(μg·L-1·h-1) and 1.75 μg·24 h-1/(μg·L-1·h-1), respectively. Besides, significant bias of UAC observed in CLIA and LC-MS/MS results indicates that appropriate definition of cutoff value and reference range for each method are mandatory.
