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01-03-2011 | Educational Review

Pathogenesis, diagnosis and management of hyperkalemia

Authors: Anja Lehnhardt, Markus J. Kemper

Published in: Pediatric Nephrology | Issue 3/2011

Abstract

Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5.5 mmol/l. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space. In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction. Treatment has to be initiated immediately using different therapeutic strategies to increase potassium shift into the intracellular space or to increase elimination, together with reduction of intake. Knowledge of the physiological mechanisms of potassium handling is essential in understanding the causes of hyperkalemia as well as its treatment. This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options.

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Klevay LM, Bogden JD, Aladjem M, Sandstead HH, Kemp FW, Li W, Skurnick J, Aviv A (2007) Renal and gastrointestinal potassium excretion in humans: new insight based on new data and review and analysis of published studies. J Am Coll Nutr 26:103–110PubMed

Kemper MJ (2009) Potassium and magnesium physiology. In: Ronco C, Bellomo R, Kellum JA (eds) Critical Care Nephrology, pp 478–482

Smith SM (2010) Thiazide diuretics. N Engl J Med 362:659–660, author reply 660PubMedCrossRef

Liu Z, Wang HR, Huang CL (2009) Regulation of ROMK channel and K+ homeostasis by kidney-specific WNK1 kinase. J Biol Chem 284:12198–12206PubMedCrossRef

Huang C, Miller RT (2007) Regulation of renal ion transport by the calcium-sensing receptor: an update. Curr Opin Nephrol Hypertens 16:437–443PubMedCrossRef

Biner HL, Arpin-Bott MP, Loffing J, Wang X, Knepper M, Hebert SC, Kaissling B (2002) Human cortical distal nephron: distribution of electrolyte and water transport pathways. J Am Soc Nephrol 13:836–847PubMed

Palmer LG, Frindt G (2000) Aldosterone and potassium secretion by the cortical collecting duct. Kidney Int 57:1324–1328PubMedCrossRef

Stanton BA, Biemesderfer D, Wade JB, Giebisch G (1981) Structural and functional study of the rat distal nephron: effects of potassium adaptation and depletion. Kidney Int 19:36–48PubMedCrossRef

Stetson DL, Wade JB, Giebisch G (1980) Morphologic alterations in the rat medullary collecting duct following potassium depletion. Kidney Int 17:45–56PubMedCrossRef

10.

Sonnenberg H, Honrath U, Wilson DR (1987) Effect of vasopressin analogue (dDAVP) on potassium transport in medullary collecting duct. Am J Physiol 252:F986–F991PubMed

11.

Su M, Stork C, Ravuri S, Lavoie T, Anguish D, Nelson LS, Hoffman RS (2001) Sustained-release potassium chloride overdose. J Toxicol Clin Toxicol 39:641–648PubMedCrossRef

12.

Margassery S, Bastani B (2001) Life-threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment. J Nephrol 14:410–414PubMed

13.

Weir MR, Rolfe M (2010) Potassium homeostasis and Renin-Angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 5:531–548PubMedCrossRef

14.

Sica DA, Gehr TW, Yancy C (2003) Hyperkalemia, congestive heart failure, and aldosterone receptor antagonism. Congest Heart Fail 9:224–229PubMedCrossRef

15.

Schambelan M, Sebastian A, Biglieri EG (1980) Prevalence, pathogenesis, and functional significance of aldosterone deficiency in hyperkalemic patients with chronic renal insufficiency. Kidney Int 17:89–101PubMedCrossRef

16.

Batlle DC, Arruda JA, Kurtzman NA (1981) Hyperkalemic distal renal tubular acidosis associated with obstructive uropathy. N Engl J Med 304:373–380PubMedCrossRef

17.

Karet FE (2009) Mechanisms in hyperkalemic renal tubular acidosis. J Am Soc Nephrol 20:251–254PubMedCrossRef

18.

Bogdanovic R, Stajic N, Putnik J, Paripovic A (2009) Transient type 1 pseudo-hypoaldosteronism: report on an eight-patient series and literature review. Pediatr Nephrol 24:2167–2175PubMedCrossRef

19.

Wilson FH, Disse-Nicodeme S, Choate KA, Ishikawa K, Nelson-Williams C, Desitter I, Gunel M, Milford DV, Lipkin GW, Achard JM, Feely MP, Dussol B, Berland Y, Unwin RJ, Mayan H, Simon DB, Farfel Z, Jeunemaitre X, Lifton RP (2001) Human hypertension caused by mutations in WNK kinases. Science 293:1107–1112PubMedCrossRef

20.

Klemm SA, Gordon RD, Tunny TJ, Thompson RE (1991) The syndrome of hypertension and hyperkalemia with normal GFR (Gordon’s syndrome): is there increased proximal sodium reabsorption? Clin Invest Med 14:551–558PubMed

21.

Speiser PW, White PC (2003) Congenital adrenal hyperplasia. N Engl J Med 349:776–788PubMedCrossRef

22.

Poggio R, Grancelli HO, Miriuka SG (2010) Understanding the risk of hyperkalaemia in heart failure: role of aldosterone antagonism. Postgrad Med J 86:136–142PubMedCrossRef

23.

Rodriguez-Soriano J, Vallo A, Ariceta G, Martul P, de la Rica I (1996) Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus. Pediatr Nephrol 10:1–6PubMedCrossRef

24.

Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N, Memoli B, Fuiano G, Esposito C, Andreucci VE (1990) Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure. Kidney Int 38:301–307PubMedCrossRef

25.

Perazella MA (2000) Drug-induced hyperkalemia: old culprits and new offenders. Am J Med 109:307–314PubMedCrossRef

26.

Martyn JA, Richtsfeld M (2006) Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology 104:158–169PubMedCrossRef

27.

Jurkat-Rott K, Holzherr B, Fauler M, Lehmann-Horn F (2010) Sodium channelopathies of skeletal muscle result from gain or loss of function. Pflugers Arch 460:239–248PubMedCrossRef

28.

Martinez-Vea A, Bardaji A, Garcia C, Oliver JA (1999) Severe hyperkalemia with minimal electrocardiographic manifestations: a report of seven cases. J Electrocardiol 32:45–49PubMedCrossRef

29.

Montague BT, Ouellette JR, Buller GK (2008) Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol 3:324–330PubMedCrossRef

30.

Owens H, Siparsky G, Bajaj L, Hampers LC (2005) Correction of factitious hyperkalemia in hemolyzed specimens. Am J Emerg Med 23:872–875PubMedCrossRef

31.

Aslam S, Friedman EA, Ifudu O (2002) Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients. Nephrol Dial Transplant 17:1639–1642PubMedCrossRef

32.

Kemper MJ, Harps E, Muller-Wiefel DE (1996) Hyperkalemia: therapeutic options in acute and chronic renal failure. Clin Nephrol 46:67–69PubMed

33.

Kemper MJ, Harps E, Hellwege HH, Muller-Wiefel DE (1996) Effective treatment of acute hyperkalaemia in childhood by short-term infusion of salbutamol. Eur J Pediatr 155:495–497PubMedCrossRef

34.

Yaseen H, Khalaf M, Dana A, Yaseen N, Darwich M (2008) Salbutamol versus cation-exchange resin (kayexalate) for the treatment of nonoliguric hyperkalemia in preterm infants. Am J Perinatol 25:193–197PubMedCrossRef

35.

Blumberg A, Weidmann P, Ferrari P (1992) Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Kidney Int 41:369–374PubMedCrossRef

36.

Bragg-Gresham JL, Fissell RB, Mason NA, Bailie GR, Gillespie BW, Wizemann V, Cruz JM, Akiba T, Kurokawa K, Ramirez S, Young EW (2007) Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS). Am J Kidney Dis 49:426–431PubMedCrossRef

37.

Bennett LN, Myers TF, Lambert GH (1996) Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650-gram infant with hyperkalemia. Am J Perinatol 13:167–170PubMedCrossRef

38.

Ricci Z, Bellomo R, Ronco C (2009) Renal replacement techniques: descriptions, mechanisms, choices and controversies. In: Ronco C, Bellomo R, Kellum JA (eds) Critical Care Nephrology. Elsevier, Saunders, pp 1136–1141

39.

Choi MJ, Ziyadeh FN (2008) The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. J Am Soc Nephrol 19:424–426PubMedCrossRef

40.

Webb NJ, Postlethwaite RJ (2003) Clinical Paediatric Nephrology, 3rd edn. Oxford University Press, p 55

Title: Pathogenesis, diagnosis and management of hyperkalemia
Authors: Anja Lehnhardt
Markus J. Kemper
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: Pediatric Nephrology / Issue 3/2011
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-010-1699-3

At a glance: The STEP trials

Springer Medicine

Pathogenesis, diagnosis and management of hyperkalemia

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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