Nephron
Original Paper
Primary Role of Hyperkalemia in the Acidosis of Hyporeninemic HypoaldosteronismMatsuda O.a · Nonoguchi H.b · Tomita K.a · Shiigai T.a · Ida T.a · Shinohara S.a · Ideura T.c · Takeuchi J.aaSecond Department of Internal Medicine, Tokyo Medical and Dental University, Yushima, Tokyo, Japan, bLaboratory of Kidney and Electrolyte Metabolism, National Institutes of Health, Bethesda, Md., USA, cDepartment of Internal Medicine, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Article / Publication Details
Accepted: September 18, 1987
Published online: December 09, 2008
Issue release date: 1988
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 0
ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)
For additional information: https://www.karger.com/NEF
Abstract
A 65-year-old woman with mild renal insufficiency had persistent hyperkalemia and hyperchloremic acidosis. Her plasma aldosterone level was relatively low for her hyperkalemia, and her urine pH was low. Fludrocortisone acetate administration corrected both hyperkalemia and acidosis by increasing urinary excretion of potassium and net acid, implicating deficient mineralocorticoid activity in the distal renal tubule in this patient. During this medication urinary ammonium excretion increased, but urine pH remained low, so that urinary titratable acid excretion did not decrease. On the other hand, correction of hyperkalemia by administration of a potassium-calcium exchange resin alone also resolved the acidosis by increasing urinary ammonium excretion. This increment exceeded the decrement of urinary titratable acid excretion, which was caused by raised urine pH secondary to increased urinary ammonium excretion, and resulted in increase of net acid excretion. Thus, in this patient, hyperkalemia appears to be a decisive causative factor in the acidosis, with deficient mineralocorticoid effect only contributing in part to the reduction of net acid excretion and the acidosis.
© 1988 S. Karger AG, Basel
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Article / Publication Details
Accepted: September 18, 1987
Published online: December 09, 2008
Issue release date: 1988
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 0
ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)
For additional information: https://www.karger.com/NEF
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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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