Renin Activity, Plasma

Other names: PLASMA RENIN ACTIVITY

check icon Optimal Result: 0.17 - 5.38 ng/mL/hr.

What is Renin?

Renin is an enzyme produced by the kidneys when blood volume, hydration, or salt levels are low. Its main function is to help regulate blood pressure and maintain fluid balance.

Renin activates a chain of reactions known as the renin–angiotensin–aldosterone system (RAAS). It converts a protein called angiotensinogen into angiotensin I, which is then transformed into angiotensin II. Angiotensin II constricts blood vessels, raises blood pressure, and signals the adrenal glands to release aldosterone. In turn, aldosterone prompts the kidneys to retain sodium and water, helping restore normal blood pressure and fluid levels.

If this system becomes overactive, it can lead to high blood pressure (hypertension) and may contribute to kidney or cardiovascular disease.

What is the Plasma Renin Activity (PRA) Test?

The Plasma Renin Activity (PRA) test measures how actively renin is working in your blood. It is often ordered together with an aldosterone test to help identify the cause of high blood pressure or abnormal sodium and potassium levels.

Measuring both hormones helps doctors determine whether hypertension is linked to:

  • Kidney disease

  • Adrenal gland disorders

  • Narrowing of the kidney arteries (renal artery stenosis)

For instance:

  • High renin levels may suggest renal artery stenosis, a narrowing of the arteries that supply blood to the kidneys, sometimes confirmed with imaging tests.

  • Low renin levels with high aldosterone may indicate primary hyperaldosteronism (Conn’s syndrome), a condition where the adrenal glands produce too much aldosterone.

Since many people with high blood pressure have no clear underlying cause, measuring PRA can help identify contributing factors and guide more personalized treatment.

Reference Ranges for Renin Activity (ng/mL/hr)

Age Group Reference Range
0–11 months 2.000–37.000
1–3 years 1.700–11.200
4–5 years 1.000–6.500
6–10 years 0.500–5.900
11–15 years 0.500–3.300
Adults (>15 years) 0.167–5.380

Adults – Sodium-depleted, upright (peripheral vein specimen)

Age Range Reference Range (ng/mL/hr) Mean
18–39 years 2.9–24.0 10.8
40+ years 2.9–10.8 5.9

Adults – Sodium-replete, upright (peripheral vein specimen)

Age Range Reference Range (ng/mL/hr) Mean
18–39 years ≤0.6–4.3 1.9
40+ years ≤0.6–3.0 1.0

Critical Values

  • A renal venous renin ratio greater than 1.5 may suggest kidney-related disease.

  • An aldosterone-to-renin ratio (ARR) of 20 or higher, with aldosterone above 15 ng/dL, strongly suggests primary hyperaldosteronism.

Sources

What does it mean if your Renin Activity, Plasma result is too high?

What Does Elevated Renin Activity Mean?

If your plasma renin activity (PRA) is higher than normal, it usually means your body is trying to raise blood pressure or adjust fluid and salt levels. Because renin triggers the release of aldosterone, doctors often measure both together to understand whether your results point to a kidney, adrenal, or blood pressure–related condition.


Possible Reasons for Elevated Renin Activity

Medical conditions

  • Secondary hypertension (high blood pressure caused by kidney or adrenal problems)

  • Renal artery stenosis (narrowing of the blood vessels supplying the kidneys)

  • Kidney tumors or other kidney disease

  • Heart failure, when circulation is reduced and the body senses low blood flow

  • Liver cirrhosis or advanced scarring, which alters blood flow and hormone signals

  • Significant blood loss (hemorrhage)

Lifestyle or timing factors

  • Low-salt diet (especially <3 grams of sodium per day)

  • Early morning testing, when renin levels naturally rise

Medications that may raise renin

  • Diuretics (“water pills”)

  • Calcium channel blockers (dihydropyridine type)

  • ACE inhibitors

  • Angiotensin receptor blockers (ARBs)


How Doctors Interpret Your Results

Because many factors can influence renin levels, results are rarely interpreted in isolation. Your doctor will usually review renin alongside:

  • Aldosterone levels

  • Electrolytes (sodium, potassium, etc.)

  • Your blood pressure history

  • Imaging studies, if needed, to check kidney or adrenal structure


Key Takeaway

An elevated renin result doesn’t point to a single condition on its own. It’s one piece of a larger puzzle that helps guide diagnosis and treatment. Always rely on your healthcare provider to put your numbers into context.

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What does it mean if your Renin Activity, Plasma result is too low?

When low levels of renin are found, it may be due to any of the following reasons:

- Secondary aldosteronism

- Use of beta-blockers

- Treatment with antidiuretic hormone

- High salt diet

- Use of clonidine

- Use of non-steroidal anti-inflammatories (NSAIDs) 

- Treatment with steroids that cause salt retention

- Use of alpha-methyldopa

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