Is there a link between primary aldosteronism and higher urinary albumin excretion?

Primary aldosteronism (PA) is a condition where the adrenal glands make too much aldosterone, a hormone that causes the body to hold onto sodium and lose potassium. This leads to high blood pressure that is often hard to control. The question is whether PA also harms the kidneys in a way that shows up as extra albumin in the urine. Albumin is a protein that normally stays in the blood; when the kidneys' filters leak, small amounts pass into urine. Higher urinary albumin excretion is a sign of kidney stress and a known marker of cardiovascular risk.

The short answer is yes. A large pooled analysis of 74 studies found that people with PA had higher urinary albumin excretion than people with ordinary high blood pressure ¹. Other research shows PA is tied to kidney function decline over time ⁸ and to higher cardiovascular risk that is not fully explained by blood pressure alone ⁵⁶.

What the research says

The strongest direct evidence comes from a meta-analysis that pooled 74 observational studies with 26,143 participants ¹. It compared people with PA to people with essential hypertension (high blood pressure without a known hormonal cause). The PA group had lower serum potassium and higher urinary albumin excretion ¹. In other words, even when both groups have high blood pressure, the PA group shows more albumin leaking into the urine. That same analysis found no significant difference in creatinine, estimated glomerular filtration rate (eGFR, a measure of how well the kidneys filter), or blood urea nitrogen between the groups ¹. So the albumin signal appeared even though standard kidney filtering tests looked similar.

Other studies support the idea that excess aldosterone harms the kidneys. A 2026 prospective study of 976 adults found that subclinical PA (milder, unrecognized aldosterone excess) was linked to a steeper decline in eGFR over time ⁸. A 2025 population-based study of 2,017 Canadian adults found that lower renin and higher aldosterone-to-renin ratios were associated with major adverse cardiovascular events over about 11 years of follow-up ⁶. These findings fit with a broader review showing that people with PA have higher cardiovascular risk than people with essential hypertension, and that this gap is not fully explained by blood pressure levels ⁵.

Researchers are still working out why aldosterone damages blood vessels and kidneys. A review of mineralocorticoid receptor antagonists and aldosterone synthase inhibitors points to inflammation as a key pathway: excess aldosterone drives immune and inflammatory changes that promote fibrosis (scarring) and vascular dysfunction ⁵. Another review notes that PA is linked to metabolic syndrome, including insulin resistance, which may add to cardiovascular risk ⁷. A separate review on endocrine causes of osteoporosis describes how PA promotes skeletal fragility through mineralocorticoid receptor activation, oxidative stress, hypercalciuria (too much calcium in urine), and secondary hyperparathyroidism ⁴. Together these sources suggest aldosterone excess affects multiple organ systems, not just blood pressure.

It is worth noting that the direct evidence on urinary albumin specifically comes mainly from the large meta-analysis ¹. The other sources address related kidney and cardiovascular outcomes rather than albumin excretion itself. A rare case report also describes a patient with both PA and a micro-pheochromocytoma, a very uncommon combination, which is a reminder that PA can coexist with other adrenal problems ³.

What to ask your doctor

• Ask whether my urinary albumin level should be checked, given my primary aldosteronism diagnosis.
• Ask what my current albumin-to-creatinine ratio (a urine test) shows and whether it has changed over time.
• Ask how my kidney function (eGFR and creatinine) is being monitored alongside my blood pressure.
• Ask whether my treatment for PA is expected to lower urinary albumin or protect my kidneys.
• Ask whether I should be screened for other cardiovascular risk factors that often accompany PA, such as metabolic syndrome.