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. Author manuscript; available in PMC: 2024 Oct 14.
Published in final edited form as: Compr Physiol. 2023 Mar 30;13(2):4409–4491. doi: 10.1002/cphy.c190043

Table 3:

Aldosterone Escape vs. Aldosterone Breakthrough

Aldosterone Escape Aldosterone Breakthrough
Definition The phenomenon of an increase in urinary Na+ excretion (UNaV) following the initial increase in Na+ reabsorption and retention caused by aldosterone. UNaV increases back to baseline levels that occurs despite continued aldosterone action. The lack of continuing suppression of the renin-angiotensin-aldosterone system (RAAS) despite treatment with RAAS blockers. Plasma aldosterone returns to previously unsuppressed and elevated baseline values, exhibiting a “breakthrough” from the suppression.
Mechanisms behind phenomena

  • Increasing renal perfusion pressure

  • Volume expansion

  • Decreased proximal Na+ reabsorption

  • Increased Na+ delivery to distal nephron

  • Inhibition of distal Na+ reabsorption

  • Decreased angiotensin II levels

  • Increased plasma renin activity
Disease state/treatment that induces phenomena Primary hyperaldosteronism Treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) in patients with hypertension, chronic kidney disease, or chronic heart failure.