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Interprets the aldosterone-to-renin ratio using active renin concentration (ARC) to screen for primary aldosteronism. Triggered when a clinician has PAC and ARC results and asks 'How do I interpret this ARR using active renin concentration?'
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
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| name | jes-pa-screening-arr-arc |
| description | Interprets the aldosterone-to-renin ratio using active renin concentration (ARC) to screen for primary aldosteronism. Triggered when a clinician has PAC and ARC results and asks 'How do I interpret this ARR using active renin concentration?' |
Collect plasma aldosterone concentration (PAC) measured by CLEIA and active renin concentration (ARC) results. Ensure PAC is ≥60 pg/mL for further interpretation.
Calculate ARR = PAC (pg/mL) / ARC (pg/mL). If ARR ≥40 and PAC ≥60 pg/mL → screen positive for primary aldosteronism. If ARR between 20 and 40 (inclusive) and PAC ≥60 pg/mL → provisionally positive (borderline). If ARR <20 or PAC <60 pg/mL → screen negative.
For positive screen (ARR ≥40, PAC ≥60 pg/mL): proceed to confirmatory testing. For provisional positive (ARR 20–40, PAC ≥60 pg/mL): individualized management considering patient desire, age, hypokalemia, adrenal tumors on CT.
If screen positive: order a confirmatory test (e.g., captopril challenge test, saline infusion test). If provisional positive: discuss individualized next steps, which may include repeat testing, confirmatory test, or medical therapy based on risk factors.
Do not rely on ARR alone if PAC <60 pg/mL; false negatives may occur. Avoid using plasma renin activity (PRA) conversion factors; the guideline specifies direct ARC use. Be aware that medications like ACE inhibitors, ARBs, calcium channel blockers, and alpha-blockers generally do not affect ARR screening results, but beta-blockers may cause false-positive and diuretics false-negative results.
A 55‑year‑old hypertensive patient has PAC 70 pg/mL (CLEIA) and ARC 1.5 pg/mL. ARR = 70 / 1.5 ≈ 46.7, which is ≥40 and PAC ≥60 pg/mL → screen positive for primary aldosteronism; proceed to confirmatory testing.
Source: Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2022, https://doi.org/10.1007/s00223-022-00903-9
TODO: consider adding scripts/calc.py for the jes-pa-screening-arr-arc calculator