Hypokalemia-induced renal dysfunction
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
Hypokalemia, especially if persistent, can induce a variety of changes in renal function, impairing tubular transport and possibly inducing chronic tubulointerstitial disease and cyst formation [1-6]. One function that is not impaired is the ability to appropriately conserve potassium, which can be important in distinguishing between extrarenal and renal sources of potassium loss when the cause of hypokalemia is not clear . (See 'Renal potassium conservation' below and "Evaluation of the adult patient with hypokalemia", section on 'Assessment of urinary potassium excretion'.)
The following renal abnormalities, most of which are reversible with potassium repletion, can be induced by hypokalemia :
●Impaired urinary concentrating ability
●Increased ammonia production
- Mount DB, Zandi-Nejad K. Disorders of potassium balance. In: Brenner and Rector's The Kidney, Brenner BM (Ed), W.B Saunders, Philadelphia 2008. p.547.
- Mujais SK, Katz AL. Potassium deficiency. In: The Kidney: Physiology and Pathophysiology, Seldin DW, Giebisch G (Eds), Lippincott Williams & Wilkins, 2000. p.1615.
- Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed, McGraw-Hill, New York 2001. p.860.
- Schwartz WB, Relman AS. Effects of electrolyte disorders on renal structure and function. N Engl J Med 1967; 276:383.
- Riemenschneider T, Bohle A. Morphologic aspects of low-potassium and low-sodium nephropathy. Clin Nephrol 1983; 19:271.
- Torres VE, Young WF Jr, Offord KP, Hattery RR. Association of hypokalemia, aldosteronism, and renal cysts. N Engl J Med 1990; 322:345.
- RUBINI ME. Water excrtion in potassium-deficient man. J Clin Invest 1961; 40:2215.
- Marples D, Frøkiaer J, Dørup J, et al. Hypokalemia-induced downregulation of aquaporin-2 water channel expression in rat kidney medulla and cortex. J Clin Invest 1996; 97:1960.
- Elkjaer ML, Kwon TH, Wang W, et al. Altered expression of renal NHE3, TSC, BSC-1, and ENaC subunits in potassium-depleted rats. Am J Physiol Renal Physiol 2002; 283:F1376.
- Luke RG, Booker BB, Galla JH. Effect of potassium depletion on chloride transport in the loop of Henle in the rat. Am J Physiol 1985; 248:F682.
- Berl T, Linas SL, Aisenbrey GA, Anderson RJ. On the mechanism of polyuria in potassium depletion. The role of polydipsia. J Clin Invest 1977; 60:620.
- Tizianello A, Garibotto G, Robaudo C, et al. Renal ammoniagenesis in humans with chronic potassium depletion. Kidney Int 1991; 40:772.
- COOKE RE, SEGAR WE, CHEEK DB, et al. The extrarenal correction of alkalosis associated with potassium deficiency. J Clin Invest 1952; 31:798.
- Jaeger P, Karlmark B, Giebisch G. Ammonium transport in rat cortical tubule: relationship to potassium metabolism. Am J Physiol 1983; 245:F593.
- Gabduzda GJ, Hall PW 3rd. Relation of potassium depletion to renal ammonium metabolism and hepatic coma. Medicine (Baltimore) 1966; 45:481.
- Artz SA, Paes IC, Faloon WW. Hypokalemia-induced hepatic coma in cirrhosis. Occurrence despite neomycin therapy. Gastroenterology 1966; 51:1046.
- Sabatini S, Kurtzman NA. The maintenance of metabolic alkalosis: factors which decrease bicarbonate excretion. Kidney Int 1984; 25:357.
- Garella S, Chazan JA, Cohen JJ. Saline-resistant metabolic alkalosis or "chloride-wasting nephropathy". Report of four patients with severe potassium depletion. Ann Intern Med 1970; 73:31.
- Cremer W, Bock KD. Symptoms and course of chronic hypokalemic nephropathy in man. Clin Nephrol 1977; 7:112.
- Menahem SA, Perry GJ, Dowling J, Thomson NM. Hypokalaemia-induced acute renal failure. Nephrol Dial Transplant 1999; 14:2216.
- Tolins JP, Hostetter MK, Hostetter TH. Hypokalemic nephropathy in the rat. Role of ammonia in chronic tubular injury. J Clin Invest 1987; 79:1447.
- Alpern RJ, Toto RD. Hypokalemic nephropathy--a clue to cystogenesis? N Engl J Med 1990; 322:398.
- Tsao T, Fawcett J, Fervenza FC, et al. Expression of insulin-like growth factor-I and transforming growth factor-beta in hypokalemic nephropathy in the rat. Kidney Int 2001; 59:96.
- Suga S, Mazzali M, Ray PE, et al. Angiotensin II type 1 receptor blockade ameliorates tubulointerstitial injury induced by chronic potassium deficiency. Kidney Int 2002; 61:951.
- Reungjui S, Roncal CA, Sato W, et al. Hypokalemic nephropathy is associated with impaired angiogenesis. J Am Soc Nephrol 2008; 19:125.
- SQUIRES RD, HUTH EJ. Experimental potassium depletion in normal human subjects. I. Relation of ionic intakes to the renal conservation of potassium. J Clin Invest 1959; 38:1134.