Figure 7.

Optimal medical treatment with MR antagonists in primary aldosteronism. The action of MR antagonists in the principal cell results in decreased ENaC-mediated urinary sodium reabsorption, and consequently decreased volume expansion and potassium and hydrogen ion excretion. If the effect of this action is sufficient, the contraction of the intravascular volume may result in a relative renal hypoperfusion and increased secretion of renin by juxtaglomerular cells. Thus, the rise in renin, from suppressed to unsuppressed, may serve as a biomarker of optimal MR antagonism in primary aldosteronism. AngII, angiotensin II. [© 2018 Illustration ENDOCRINE SOCIETY]