42 - Primary aldosteronism insights from a nephrologist (18 min)

Up to 30% of hypertensive patients in specialty care settings may have underlying Primary Aldosteronism (PA), yet a massive diagnostic gap still exists in screening for PA. In this episode, Maeson Latsko, PhD, and Jeffrey Hymes, MD, discuss the critical intersection of resistant hypertension, chronic kidney disease (CKD), and PA. They shed light on the direct, blood-pressure-independent toxicity of excess aldosterone on the kidneys and unpack the latest clinical guidelines from the AHA/ACC and Endocrine Society. They also review a guideline-based algorithm designed to streamline screening and follow-up for PA evaluation. This episode will - Explore the bidirectional relationship between chronic kidney disease (CKD) and hypertension, recognizing Primary Aldosteronism (PA) as a highly prevalent underlying cause (4:25) - Detail the direct toxicities of excess aldosterone, independent of systemic blood pressure (8:50) - Review updated clinical guidelines and a practical diagnostic algorithm to screen, triage, and manage PA patients (12:45)   Ordering information - Kidney Profile - Kidney Profile with reflex to eGFR (Creatinine-Cystatin C) - Kidney Profile with eGFR (Creatinine-Cystatin C) - eGFR (Creatinine-Cystatin C) <!--THE END--> - Plasma Renin Activity with Reflex to Aldosterone     Additional resources - Clinical Education Center | Quest Diagnostics - Interpretation of Plasma Renin Activity With Reflex to Aldosterone Test (test code 13817) | Algorithm | Quest Diagnostics - Primary aldosteronism algorithm brochure - Quest Diagnostics nephrology brochure - Primary aldosterone landing page - Hypertension insights landing page     Reference List 1. Whelton PK, Carey RM, Aronow WS, et al. 2025 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. *Hypertension*. 2025;85(4):e123-e145. 2. Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. *J Clin Endocrinol Metab*. 2016;101(5):1889-1916. doi:10.1210/jc.2015-4061 3. Adler GK, Stowasser M, Correa RR, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. *J Clin Endocrinol Metab*. 2025;110(9):2453-2495. doi:10.1210/clinem/dgaf284 4. Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173(1):10-20. doi:10.7326/M20-0065