Introduction Caused by the kidneys being fooled into thinking that there is low intravascular volume results in overactivation of the renin-angiotensin system associated with a high plasma renin levels Most commonly caused by by renal artery stenosis other causes include chronic renal failure CHF cirrhosis nephrotic syndrome Presentation Symptoms hypertension (secondary to increased plasma volume secondary to increased sodium reabsorption) headache polyuria (secondary to hypokalemic nephropathy) muscle weakness (secondary to hypokalemia) Physical exam tetany (hypokalemia) parestesias peripheral edema in severe cases Evaluation Labs hypokalemia hypernatremia high plasma renin (neg. regulation by high aldsterone) low plasma renin in primary hyperaldosteronism elevated 24-hour urine aldosterone metabolic alkalosis (dumping H+ for Na+) Obtain imaging to look for adrenal or pituitary mass Treatment Treat underlying cause Beta blockers or diuretic for hypertension