Aldosterone-Mediated Sodium Retention Is Reflected by the Serum Sodium to Urinary Sodium to (Serum Potassium)2 to Urinary Potassium (SUSPPUP) Index.

Evelien Kanaan,Martin Reincke,Matthias Haase,Matthias Schott,Holger S Willenberg,Oliver Vonend

doi:10.3390/diagnostics10080545

Abstract

The serum sodium to urinary sodium ratio divided by the (serum potassium)2 to urinary potassium ratio (SUSPPUP formula) reflects aldosterone action. We here prospectively investigated into the usefulness of the SUSPPUP ratio as a diagnostic tool in primary hyperaldosteronism. Parallel measurements of serum and urinary sodium and potassium concentrations (given in mmol/L) in the fasting state were done in 225 patients. Of them, 69 were diagnosed with primary aldosteronism (PA), 102 with essential hypertension (EH), 26 with adrenal insufficiency (AI) and 28 did not suffer from the above-mentioned disorders and were assigned to the reference group (REF). The result of the SUSPPUP formula was highest in the PA group (7.4, 4.2–12.3 L/mmol), followed by EH (3.2, 2.3–4.3 L/mmol), PA after surgery (3.9, 3.0–6.0 L/mmol), REF (3.4 ± 1.4 L/mmol) and AI (2.9 +/− 1.2 L/mmol). The best sensitivity in distinguishing PA from EH was reached by multiplication of the aldosterone to renin-ratio (ARR) with the SUSPPUP formula (92.7% at a cut off > 110 L/mmol), highest specificity was reached by the SUSPPUP determinations (87.2%). The integration of the SUSPPUP ratio into the ARR helps to improve the diagnosis of hyperaldosteronism substantially.

Highlights

Sodium retention is regulated by aldosterone which is secreted in dependency of potassium, angiotensin II and other stimuli [1]
Disturbed potassium and sodium chloride sensing in zona glomerulosa cells may result in autonomous secretion of aldosterone [2,3,4,5,6,7,8], termed primary aldosteronism (PA), which leads to sodium retention and through active mechanisms of water conservation to hypervolemic hypertension [9]
The inverse relation of sodium and potassium concentrations in the serum and the urine of individuals affected by PA is reflected by the sodium to urinary sodium ratio divided by the2 to urinary potassium (SUSPPUP) ratio [11]

Summary

Introduction

Sodium retention is regulated by aldosterone which is secreted in dependency of potassium, angiotensin II and other stimuli [1]. Disturbed potassium and sodium chloride sensing in zona glomerulosa cells may result in autonomous secretion of aldosterone [2,3,4,5,6,7,8], termed primary aldosteronism (PA), which leads to sodium retention and through active mechanisms of water conservation to hypervolemic hypertension [9]. The conservation and dilution of sodium happens on the expense of potassium and protons which led to the classical description of PA as hypokalemic hypertension with metabolic alkalosis [10]. A large retrospective study suggested that serum potassium measurements

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Conclusion