Last updated: October 2, 2025
Renovascular hypertension and other causes of elevated renin levels are uncommon but potentially treatable sources of high blood pressure. Modern diagnosis of renovascular hypertension primarily relies on noninvasive imaging techniques. Although renal venous renin sampling was popular in the 1970s and early 1980s, it has fallen out of favor due to its limited overall accuracy. However, in certain situations, renal venous renin sampling can be helpful, particularly in determining the significance of bilateral but asymmetric renal artery disease. It can also be useful in assessing the secretory function of a kidney suspected of segmental atrophy or in diagnosing renal juxtaglomerular tumors (reninomas). Normally, there is little difference in renin secretion between the two kidneys. Unilateral increased renin secretion, regardless of the cause, usually leads to elevated blood pressure and suppression of renin production on the opposite side. Therefore, identifying lateralization of high renin levels to one side can confirm asymmetric vascular disease or focal abnormal renin secretion.
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Anatomy
Indications
In cases where there is discussion concerning the contribution of a renal artery stenosis to hypertension noet treatable by medication, but also in case of suspicion of a renin producing proces like a juxtaglomerular cell tumor
Contra Indications
- None specific
Workup
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- Discontinue all antihypertensive medications for 10–14 days before renal venous renin sampling, if feasible (most important for ACE inhibitors and β-blockers)
- Ensure the patient is relaxed and positioned supine for at least 2 hours before the procedure
- Consider administering captopril 60–90 minutes prior to sampling to enhance discriminatory capacity by increasing the difference in renal venous renin levels between sides
Material
Essentials
- 4-F or 5-F vascular sheath
- 4-F or 5-F Cobra catheter
- Microcatheter (2.5 F or greater) for segmental sampling
- Needles and syringes for blood sampling
- Sample collection tubes (EDTA lavender-top tubes)
- Ice for sample preservation
Non Essentials
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Positioning
Supine
Steps
- Access the venous system via the internal jugular vein (IJV) or femoral vein (preferred by most practitioners)
- Insert a 4-F or 5-F vascular sheath through the common femoral vein
- Use a 4-F or 5-F Cobra catheter to sequentially select renal veins
- Position the catheter centrally in the right renal vein to reflect the entire kidney's effluent; on the left, sample peripherally to avoid dilution from gonadal vein inflow or IVC variants
- Obtain 2–3 samples of 8–10 mL from each side
- Also collect infrarenal IVC blood samples
- Samples should be obtained rapidly to account for variability in renin levels over time
- For suspected segmental arterial disease or focal renin secretion, perform segmental renal vein sampling using a high-flow microcatheter (2.5 F or greater) for selective catheterization
- Label the samples, separate plasma by centrifuge, transfer to EDTA tubes, keep on ice, and send for LC-MS/MS analysis
Tips & Tricks
Complications
- Groin hematoma, occurring in 3%–4% of cases.
Aftercare
- None specific
Folder
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Literature
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