Yes, MRAs can cause mild hyponatremia. Usually not a major issue but can be a factor. I have not seen severe hyponatremia (eg <125) and use a lot.

Aldosterone deficient mice are mildly hyponatremic (inconsistently)
Primary aldosteronism is associated with mild hypernatremia

Tolerate if really needed, but taper as BP falls after spironolactone takes effect- usually weeks to 3 months

42% sensitivity is what you want in a screening test, right? [sarcasm]

almost always lower dose 12.5-25, occasionally higher 50-100mg.
hyperkalemia/CKD > gynecomastia > dysmenorrhea of course can be limiting

Yes you should be able to reduce medications after adding Spironolactone.
I withdraw based on other adverse med effects (edema = CCB; K = thiazide/RAASi)

I use this figure in my talks on Resistant HTN...(observational, but holds up imo)

pubmed.ncbi.nlm.nih.gov/11991219/

Bring back methyldopa too!

Standardized treatment in advance-HTN included thiazide + ARB for all.

Upcoming Launch-HTN uses standard background meds so will be a mix of real world regimens.
Longer term open label followup is ongoing too.

I'm gonna guess Geriatrics

*in rodents

Hyponatremia define here as <135, and also while all patients on a thiazide. Suspect clinically significant hypoNa is much less common.
#NephJC

I do not have any inside info- doesn't look like it is being studied in the US, likely due to lack of patent protection. But it appears much less selective than newer agents. It is just R-fadrazole.

the bigger issue is - don't block cortisol synthesis, which ramps up ACTH and revs up the steroid pathway and further augments DOC accumulation.
#NephJC

btw @kidneyboy.bsky.social this pathway needs to be taught to our Neph fellows so they can think this problem out like you're doing

Indapamide 2.5mg or if previously on HCTZ continue that dose (if I recall correctly).
Plus Olmesartan 40mg in all.
If previously on 3 drugs then Amlodipine 10mg or max tolerated dose used.
#NephJC

absolutely.

Not sure the numbers are sig different, but I think your rationale is correct. The dose would have been pushed up to 100mg only in the most resistant #NephJC

Theoretically:
- it targets the primary issue in many patients- unregulated aldosterone production.
-avoid effect of further elevated Aldo during MRA treatment

Obvs -avoid gynecomastia and off-target effects of Spiro.
For other MRAs it has always been difficult to push dose high enough.
#NephJC