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Renal tubular acidosis type IV in hyperkalaemic patients – a fairy tale or reality?
Author(s) -
Haas Christian S.,
Pohlenz Inga,
Lindner Ulrich,
Muck Philip M.,
Arand Jovana,
Suefke Sven,
Lehnert Hendrik
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2012.04446.x
Subject(s) - medicine , hyperkalemia , renal function , acidosis , metabolic acidosis , renal tubular acidosis , creatinine , acute kidney injury , urology , distal renal tubular acidosis , aldosterone , endocrinology , kidney disease , gastroenterology
Objective Hyperkalaemia is a common feature in hospitalized patients and often attributed to drugs antagonizing the renin‐angiotensin‐aldosterone system ( RAAS ) and/or acute kidney injury ( AKI ), despite significantly preserved glomerular filtration rate ( GFR ). The objective of this study was to determine the prevalence and role of renal tubular acidosis type IV ( RTA IV ) in the development of significant hyperkalaemia. Design A single‐centre retrospective study. Patients Patients admitted to a University Hospital over 12 months. Measurements Patients with a potassium value > 6·0 m m were identified. Clinical and laboratory data were revisited, and patients with a normal anion gap metabolic acidosis were evaluated for the existence of RTA IV . Results A total of 57 patients having significant hyperkalaemia (>6·0 m m ) were identified. Twelve patients had end‐stage renal disease, while 21 patients had solely AKI or progressive chronic renal failure. RTA IV was present in 24 patients (42%), of whom 71% had pre‐existing renal insufficiency because of diabetic nephropathy or tubulointerstitial nephritis. All hyperkalaemic patients with urinary/serum electrolytes suggestive of RTA IV had evidence of AKI , but creatinine levels were significantly lower ( P < 0·05), while the number of drugs antagonizing the RAAS was comparable. Conclusion We demonstrated that RTA IV (i) is very common in patients with hyperkalaemia; (ii) should always be suspected in hyperkalaemic patients with only moderately impaired GFR ; and (iii) may result in significant hyperkalaemia in the presence of both AKI and drugs antagonizing the RAAS .