How do I install the Jes Pa Screening Arr Arc skill?

Run npx skillmds@latest add dromlakhani/jes-pa-screening-arr-arc in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Is Jes Pa Screening Arr Arc free to use?

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Who published Jes Pa Screening Arr Arc?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Jes Pa Screening Arr Arc by dromlakhani

Name: Jes Pa Screening Arr Arc
Rating: 4.2 (5 reviews)
Author: dromlakhani

Jes Pa Screening Arr Arc

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?'

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Interpret aldosterone-to-renin ratio screening test using PAC/ARC

STEP 1 — Gather Information

Collect plasma aldosterone concentration (PAC) measured by CLEIA and active renin concentration (ARC) results. Ensure PAC is ≥60 pg/mL for further interpretation.

STEP 2 — Rule In / Rule Out

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.

STEP 3 — Classify or Stratify

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.

STEP 4 — Decide

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.

Clinical Guardrails / Mimics / Pitfalls

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.

Concrete Clinical Example

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

---name: jes-pa-screening-arr-arcdescription: 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?'---# Interpret aldosterone-to-renin ratio screening test using PAC/ARC## STEP 1 — Gather InformationCollect plasma aldosterone concentration (PAC) measured by CLEIA and active renin concentration (ARC) results. Ensure PAC is ≥60 pg/mL for further interpretation.## STEP 2 — Rule In / Rule OutCalculate 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.## STEP 3 — Classify or StratifyFor 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.## STEP 4 — DecideIf 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.## Clinical Guardrails / Mimics / PitfallsDo 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.## Concrete Clinical ExampleA 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

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