Selective Aldosterone Deficiency in Chronic Pyelonephritis

Abstract

Serum K concentration is usually normal or moderately elevated in chronic renal insufficiency. Severe hyperkalemia, disproportionate to the degree of renal deficiency, has been frequently observed in chronic pyelonephritis; its pathogenesis is still unknown. Marked elevation of serum potassium was observed in a patient with chronic pyelonephritis and simultaneous selective deficiency of aldosterone. The hyperkalemia was corrected by mineralocorticoid replacement therapy. In some cases of chronic pyelonephritis selective aldosterone deficiency may be responsible for the marked hyperkalemia.

Recurrent Hyperkalaemia due to Selective Aldosterone Deficiency: Correction by Angiotensin Infusion

“…The syndrome seems to be rare since only 21 further cases have been recorded (Skanse and Hokfelt, 1958;Hill et al, 1959;Lambrew et al, 1961;Rick et al, 1962;Posner and Jacobs, 1964;Wilson and Goetz, 1964;Gerstein et al, 1968;Vagnucci, 1969;McGiff et al, 1970;Vagnucci, 1970;Ferrara et al, 1970;Perez et al, 1972;Schambelan et al, 1972;Mellinger et al, 1972;Weidman et al, 1972;Brown et al, 1972a).…”

Role of the Renin-Angiotensin-Aldosterone System in the Regulation of Plasma Potassium in Chronic Renal Disease

“…Several studies suggest the possibility that some patients with nonoliguric renal disease may develop hyperkalemia associated with renin and/or aldosterone deficiency [17,31,33,36,40,42],…”

Renal Tubular Acidosis

“…This possibility is supported by the observation that the acidosis is ameliorated by the administration of mineralocorticoid in some (62) but not in all instances (60,61).…”

“…This observation coupled with the low levels of aldosterone often found in these patients led to the speculation that aldosterone defi ciency could be respon sible for the observed acidosis by retarding distal bicarbonate reabsorption (29,60,61). This possibility is supported by the observation that the acidosis is ameliorated by the administration of mineralocorticoid in some (62) but not in all instances (60,61).…”