Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Suppression of Plasma Renin Activity in a Boy With Chronic Hyperkalemia

Suppression of Plasma Renin Activity in a Boy With Chronic Hyperkalemia Abstract • Chronic hyperkalemia (6.8 mmol/L [6.8 mEq/L]) was discovered in a boy, aged 13 years 7 months, with short stature, delayed puberty, and normal blood pressure. Additional studies revealed hyperchloremic metabolic acidosis (serum values: sodium Ion, 139 mmol/L [139 mEq/L]; chloride, 113 mmol/L [113 mEq/L]; bicarbonate, 18 mmol/L [18 mEq/L]), a normal glomerular filtration rate, a subnormal renal threshold for bicarbonate reabsorption, and normal serum thyroxine, growth hormone, and cortisol values. Renal excretion of potassium ion was subnormal for the prevailing serum concentration of potassium ion but was Increased normally by infusion of sodium sulfate. The serum aldosterone concentration was appropriate for a normokalemic subject, despite marked suppression of plasma renin activity (PRA) (supine/upright: aldosterone, 140/580 pmol/L [5/21 ng/dL]; PRA, 0.0/0.03 ng/L·s [0.0/0.1 ng/mL/h]). Treatment with chlorothiazide and sodium chloride resulted in correction of the abnormal electrolyte concentrations and an increase in linear growth velocity. Serum aldosterone concentrations did not change significantly during treatment, even though the PRA had increased (supine/upright: aldosterone, 110/920 pmol/L [4/33 ng/dL]; PRA, 0.89/2.17 ng/L·s [3.2/7.8 ng/mL/h]). In this patient, we conclude that (1) hyperkalemia was due to inadequate renal excretion of potassium ion; (2) the serum potassium ion concentration was the major stimulus to aldosterone secretion before treatment; (3) suppression of PRA was more likely due to hyperkalemia than to extracellular volume expansion. (AJDC 1987;141:922-927) References 1. Dluhy RG, Greenfield M, Williams GH: Effect of simultaneous potassium and saline loading on plasma aldosterone levels . J Clin Endocrinol Metab 1977;45:141-146.Crossref 2. Brunner HR, Baer L, Sealey JE, et al: The influence of potassium administration and of potassium deprivation on plasma renin in normal and hypertensive subjects . J Clin Invest 1970;49: 2128-2138.Crossref 3. Silva P, Brown RS, Epstein FH: Adaptation to potassium . Kidney Int 1977;11:466-475.Crossref 4. Spitzer A, Edelmann CM Jr, Goldberg LD, et al: Short stature, hyperkalemia and acidosis: A defect in renal transport of potassium . Kidney Int 1973;3:251-257.Crossref 5. Weinstein SF, Allan DME, Mendoza SA: Hyperkalemia, acidosis, and short stature associated with a defect in renal potassium excretion . J Pediatr 1974;85:355-358.Crossref 6. Blumenthal S, Epps RP, Heavenrich R, et al: Report of the task force on blood pressure control in children . Pediatrics 1977;59( (suppl) ): 797-820. 7. Marshall WA, Tanner JM: Variations in the pattern of pubertal changes in boys . Arch Dis Child 1970;45:13-23.Crossref 8. Halperin ML, Goldstein MB, Haig A, et al: Studies on the pathogenesis of type I (distal) renal tubular acidosis as revealed by the urinary Pco2 tension . J Clin Invest 1974;53:669-677.Crossref 9. De Fronzo RA, Taufield PA, Black H, et al: Impaired renal tubular potassium secretion in sickle cell disease . Ann Intern Med 1979;90: 310-316.Crossref 10. Gruelich WW, Pyle SI: Atlas of Skeletal Development of the Hand and Wrist , ed 2. Stanford, Calif, Stanford University Press, 1955. 11. Rodríguez-Soriano J, Boichis H, Stark H, et al: Proximal renal tubular acidosis: A defect in bicarbonate reabsorption with normal urinary acidification . Pediatr Res 1967;1:81-98.Crossref 12. Plotnick LP, Thompson RG, Kowarski A, et al: Circadian variation of integrated concentration of growth hormone in children and adults . J Clin Endocrinol Metab 1975;40:240-247.Crossref 13. Sauder SE, Corley KP, Hopwood NJ, et al: Subnormal gonadotropin responses to gonadotropin-releasing hormone (GnRH) persist into puberty in children with isolated growth hor-[ill]mone [ill]mone deficiency . J Clin Endocrinol Metab [ill] 1981;53:1186-1192.Crossref 14. Williams GH, Rose LI, Dluhy RG, et al: Aldosterone response to sodium restriction and ACTH stimulation in panhypopituitarism . J Clin Endocrinol Metab 1971;32:27-35.Crossref 15. Arnold JE, Healy JK: Hyperkalemia, hypertension and systemic acidosis without renal failure associated with a tubular defect in potas[ill]sium excertion . Am J Med 1969;47:461-472.Crossref 16. Gordon RD, Geddes RA, Pawsey GK, et al: Hypertension and severe hyperkalaemia associated with suppression of renin and aldosterone and completely reversed by dietary sodium restriction . Aust NZ J Med 1970;4:287-294. 17. Brautbar N, Levi J, Rosier A, et al: Famil[ill]ial hyperkalemia, hypertension, and hyporeninemia with normal aldosterone levels: A tubular defect in potassium handling . Arch Intern Med 1978;138:607-610.Crossref 18. Farfel Z, Iaina A, Rosenthal T, et al: Familial hyperpotassemia and hypertension accompanied by normal plasma aldosterone levels: Possible hereditary cell membrane defect . Arch Intern Med 1978;138:1828-1832.Crossref 19. Lee MR, Ball SG, Thomas TH, et al: Hypertension and hyperkalaemia responding to bendrofluazide . Q J Med 1979;48:245-258. 20. Schambelan M, Sebastian A, Rector FS Jr: Mineralocorticoid-resistant renal hyperkalemia without salt wasting (type II pseudohypoaldosteronism): Role of increased renal chloride reabsorption . Kidney Int 1981;19:716-727.Crossref 21. Sanjad SA, Mansour FM, Hernández RH, et al: Severe hypertension, hyperkalemia, and renal tubular acidosis responding to dietary sodium restriction . Pediatrics 1982;69:317-324. 22. Grekin RJ, Nicholls MG, Padfield PL: Disorders of chloriuretic hormone secretion . Lancet 1979;1:1116-1118.Crossref 23. Young DB, Paulsen AW: Interrelated effects of aldosterone and plasma potassium on potassium excretion . Am J Physiol 1983;244: F28-F34. 24. Velázquez H, Wright FS, Good DW: Luminal influences on potassium secretion: Chloride replacement with sulfate . Am J Physiol 1982;242: F46-F55. 25. Good DW, Wright FS: Luminal influences on potassium secretion: Sodium concentration and fluid flow rate . Am J Physiol 1979;236:F192-F205. 26. Giebisch G, Malnic G, Berliner RW: Renal transport and control of potassium excretion , in Brenner BM, Rector FC Jr (eds): The Kidney . Philadelphia, WB Saunders Co, 1986, pp 192-194. 27. Kurtzman NA, White MG, Rogers PW: The effect of potassium and extracellular volume on renal bicarbonate reabsorption . Metabolism 1973;22:481-492.Crossref 28. McCaa RE, McCaa CS, Guyton AC: Role of angiotensin II and potassium in the long-term regulation of aldosterone secretion in intact conscious dogs . Circ Res 1975, (suppl 1) , pp I57-167. 29. Dluhy RG, Axelrod L, Underwood RH, et al: Studies of the control of plasma aldosterone concentration in normal man: II. Effect of dietary potassium and acute potassium infusion . J Clin Invest 1972;51:1950-1957.Crossref 30. Bayard F, Cooke CR, Tiller DJ, et al: The regulation of aldosterone secretion in anephric man . J Clin Invest 1971;50:1585-1595.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Suppression of Plasma Renin Activity in a Boy With Chronic Hyperkalemia

Loading next page...
 
/lp/american-medical-association/suppression-of-plasma-renin-activity-in-a-boy-with-chronic-5E3hZ5fR1V
Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1987.04460080108041
Publisher site
See Article on Publisher Site

Abstract

Abstract • Chronic hyperkalemia (6.8 mmol/L [6.8 mEq/L]) was discovered in a boy, aged 13 years 7 months, with short stature, delayed puberty, and normal blood pressure. Additional studies revealed hyperchloremic metabolic acidosis (serum values: sodium Ion, 139 mmol/L [139 mEq/L]; chloride, 113 mmol/L [113 mEq/L]; bicarbonate, 18 mmol/L [18 mEq/L]), a normal glomerular filtration rate, a subnormal renal threshold for bicarbonate reabsorption, and normal serum thyroxine, growth hormone, and cortisol values. Renal excretion of potassium ion was subnormal for the prevailing serum concentration of potassium ion but was Increased normally by infusion of sodium sulfate. The serum aldosterone concentration was appropriate for a normokalemic subject, despite marked suppression of plasma renin activity (PRA) (supine/upright: aldosterone, 140/580 pmol/L [5/21 ng/dL]; PRA, 0.0/0.03 ng/L·s [0.0/0.1 ng/mL/h]). Treatment with chlorothiazide and sodium chloride resulted in correction of the abnormal electrolyte concentrations and an increase in linear growth velocity. Serum aldosterone concentrations did not change significantly during treatment, even though the PRA had increased (supine/upright: aldosterone, 110/920 pmol/L [4/33 ng/dL]; PRA, 0.89/2.17 ng/L·s [3.2/7.8 ng/mL/h]). In this patient, we conclude that (1) hyperkalemia was due to inadequate renal excretion of potassium ion; (2) the serum potassium ion concentration was the major stimulus to aldosterone secretion before treatment; (3) suppression of PRA was more likely due to hyperkalemia than to extracellular volume expansion. (AJDC 1987;141:922-927) References 1. Dluhy RG, Greenfield M, Williams GH: Effect of simultaneous potassium and saline loading on plasma aldosterone levels . J Clin Endocrinol Metab 1977;45:141-146.Crossref 2. Brunner HR, Baer L, Sealey JE, et al: The influence of potassium administration and of potassium deprivation on plasma renin in normal and hypertensive subjects . J Clin Invest 1970;49: 2128-2138.Crossref 3. Silva P, Brown RS, Epstein FH: Adaptation to potassium . Kidney Int 1977;11:466-475.Crossref 4. Spitzer A, Edelmann CM Jr, Goldberg LD, et al: Short stature, hyperkalemia and acidosis: A defect in renal transport of potassium . Kidney Int 1973;3:251-257.Crossref 5. Weinstein SF, Allan DME, Mendoza SA: Hyperkalemia, acidosis, and short stature associated with a defect in renal potassium excretion . J Pediatr 1974;85:355-358.Crossref 6. Blumenthal S, Epps RP, Heavenrich R, et al: Report of the task force on blood pressure control in children . Pediatrics 1977;59( (suppl) ): 797-820. 7. Marshall WA, Tanner JM: Variations in the pattern of pubertal changes in boys . Arch Dis Child 1970;45:13-23.Crossref 8. Halperin ML, Goldstein MB, Haig A, et al: Studies on the pathogenesis of type I (distal) renal tubular acidosis as revealed by the urinary Pco2 tension . J Clin Invest 1974;53:669-677.Crossref 9. De Fronzo RA, Taufield PA, Black H, et al: Impaired renal tubular potassium secretion in sickle cell disease . Ann Intern Med 1979;90: 310-316.Crossref 10. Gruelich WW, Pyle SI: Atlas of Skeletal Development of the Hand and Wrist , ed 2. Stanford, Calif, Stanford University Press, 1955. 11. Rodríguez-Soriano J, Boichis H, Stark H, et al: Proximal renal tubular acidosis: A defect in bicarbonate reabsorption with normal urinary acidification . Pediatr Res 1967;1:81-98.Crossref 12. Plotnick LP, Thompson RG, Kowarski A, et al: Circadian variation of integrated concentration of growth hormone in children and adults . J Clin Endocrinol Metab 1975;40:240-247.Crossref 13. Sauder SE, Corley KP, Hopwood NJ, et al: Subnormal gonadotropin responses to gonadotropin-releasing hormone (GnRH) persist into puberty in children with isolated growth hor-[ill]mone [ill]mone deficiency . J Clin Endocrinol Metab [ill] 1981;53:1186-1192.Crossref 14. Williams GH, Rose LI, Dluhy RG, et al: Aldosterone response to sodium restriction and ACTH stimulation in panhypopituitarism . J Clin Endocrinol Metab 1971;32:27-35.Crossref 15. Arnold JE, Healy JK: Hyperkalemia, hypertension and systemic acidosis without renal failure associated with a tubular defect in potas[ill]sium excertion . Am J Med 1969;47:461-472.Crossref 16. Gordon RD, Geddes RA, Pawsey GK, et al: Hypertension and severe hyperkalaemia associated with suppression of renin and aldosterone and completely reversed by dietary sodium restriction . Aust NZ J Med 1970;4:287-294. 17. Brautbar N, Levi J, Rosier A, et al: Famil[ill]ial hyperkalemia, hypertension, and hyporeninemia with normal aldosterone levels: A tubular defect in potassium handling . Arch Intern Med 1978;138:607-610.Crossref 18. Farfel Z, Iaina A, Rosenthal T, et al: Familial hyperpotassemia and hypertension accompanied by normal plasma aldosterone levels: Possible hereditary cell membrane defect . Arch Intern Med 1978;138:1828-1832.Crossref 19. Lee MR, Ball SG, Thomas TH, et al: Hypertension and hyperkalaemia responding to bendrofluazide . Q J Med 1979;48:245-258. 20. Schambelan M, Sebastian A, Rector FS Jr: Mineralocorticoid-resistant renal hyperkalemia without salt wasting (type II pseudohypoaldosteronism): Role of increased renal chloride reabsorption . Kidney Int 1981;19:716-727.Crossref 21. Sanjad SA, Mansour FM, Hernández RH, et al: Severe hypertension, hyperkalemia, and renal tubular acidosis responding to dietary sodium restriction . Pediatrics 1982;69:317-324. 22. Grekin RJ, Nicholls MG, Padfield PL: Disorders of chloriuretic hormone secretion . Lancet 1979;1:1116-1118.Crossref 23. Young DB, Paulsen AW: Interrelated effects of aldosterone and plasma potassium on potassium excretion . Am J Physiol 1983;244: F28-F34. 24. Velázquez H, Wright FS, Good DW: Luminal influences on potassium secretion: Chloride replacement with sulfate . Am J Physiol 1982;242: F46-F55. 25. Good DW, Wright FS: Luminal influences on potassium secretion: Sodium concentration and fluid flow rate . Am J Physiol 1979;236:F192-F205. 26. Giebisch G, Malnic G, Berliner RW: Renal transport and control of potassium excretion , in Brenner BM, Rector FC Jr (eds): The Kidney . Philadelphia, WB Saunders Co, 1986, pp 192-194. 27. Kurtzman NA, White MG, Rogers PW: The effect of potassium and extracellular volume on renal bicarbonate reabsorption . Metabolism 1973;22:481-492.Crossref 28. McCaa RE, McCaa CS, Guyton AC: Role of angiotensin II and potassium in the long-term regulation of aldosterone secretion in intact conscious dogs . Circ Res 1975, (suppl 1) , pp I57-167. 29. Dluhy RG, Axelrod L, Underwood RH, et al: Studies of the control of plasma aldosterone concentration in normal man: II. Effect of dietary potassium and acute potassium infusion . J Clin Invest 1972;51:1950-1957.Crossref 30. Bayard F, Cooke CR, Tiller DJ, et al: The regulation of aldosterone secretion in anephric man . J Clin Invest 1971;50:1585-1595.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Aug 1, 1987

References