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Wang L, Wu G, Peng JB. Identification of a novel KLHL3-interacting motif in the C-terminal region of WNK4. Biochem Biophys Res Commun 2023; 670:87-93. [PMID: 37285722 DOI: 10.1016/j.bbrc.2023.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
Mutations in with-no-lysine [K] kinase 4 (WNK4) and kelch-like 3 (KLHL3) are linked to pseudohypoaldosteronism type 2 (PHAII, also known as familial hyperkalemic hypertension or Gordon's syndrome). WNK4 is degraded by a ubiquitin E3 ligase with KLHL3 as the substrate adaptor for WNK4. Several PHAII-causing mutations, e.g. those in the acidic motif (AM) of WNK4 and in the Kelch domain of KLHL3, impair the binding between WNK4 and KLHL3. This results in a reduction in WNK4 degradation and an increase in WNK4 activity, leading to PHAII. Although the AM is important in interacting with KLHL3, it is unclear whether this is the only motif in WNK4 responsible for KLHL3-interacting. In this study, a novel motif of WNK4 that is capable of mediating the degradation of the protein by KLHL3 was identified. This C-terminal motif (termed as CM) is located in amino acids 1051-1075 of WNK4 and is rich in negatively charged residues. Both AM and CM responded to the PHAII mutations in the Kelch domain of KLHL3 in a similar manner, but AM is dominant among the two motifs. The presence of this motif likely allows WNK4 protein to respond to the KLHL3-mediated degradation when the AM is dysfunctional due to a PHAII mutation. This may be one of the reasons why PHAII is less severe when WNK4 is mutated compared to KLHL3 is mutated.
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Affiliation(s)
- Lingyun Wang
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Guojin Wu
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Ji-Bin Peng
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, University of Alabama at Birmingham, Birmingham, AL, 35294, USA; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
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2
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Rehman MZ, Melamed M, Harris A, Shankar M, Rosa RM, Batlle D. Urinary Ammonium in Clinical Medicine: Direct Measurement and the Urine Anion Gap as a Surrogate Marker During Metabolic Acidosis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:197-206. [PMID: 36868734 DOI: 10.1053/j.akdh.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 03/05/2023]
Abstract
Ammonium is the most important component of urinary acid excretion, normally accounting for about two-third of net acid excretion. In this article, we discuss urine ammonium not only in the evaluation of metabolic acidosis but also in other clinical conditions such as chronic kidney disease. Different methods to measure urine NH4+ that have been employed over the years are discussed. The enzymatic method used by clinical laboratories in the United States to measure plasma ammonia via the glutamate dehydrogenase can be used for urine ammonium. The urine anion gap calculation can be used as a rough marker of urine ammonium in the initial bedside evaluation of metabolic acidosis such as in distal renal tubular acidosis. Urine ammonium measurements, however, should be made more available in clinical medicine for a precise evaluation of this important component of urinary acid excretion.
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Affiliation(s)
- Mohammed Z Rehman
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michal Melamed
- Department of Medicine (Nephrology), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Autumn Harris
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, Gainesville, FL
| | - Mythri Shankar
- Department of Nephrology, Institute of Nephro-urology, Bengaluru, India
| | - Robert M Rosa
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel Batlle
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Sun Y, Wang S, Wang F, Zhang H, Huang W, Wu A, Zhang Y. One-step rapid colorimetric detection of K + using silver nanoparticles modified by crown ether. Analyst 2023; 148:344-353. [PMID: 36533333 DOI: 10.1039/d2an01840c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urinary potassium is an important parameter in clinical health diagnosis. Rapid and convenient detection of potassium ions (K+) in urine is essential for personal healthcare and health management. Here, crown ether (4-aminodibenzo-18-crown-6, ADC) modified silver nanoparticles (ADC-Ag NPs) were successfully prepared for one-step rapid colorimetric detection of urinary potassium. The detection mechanism is as follows: due to the matching sizes of the diameter of K+ and the cavity in crown ether 6, K+ is encapsulated between the cavities of two crown ethers, resulting in the clumping of ADC-Ag NPs and the color of the solution being altered. The colorimetric detection method has a fast response and is completed within 20 minutes. It also shows good selectivity and interference immunity. The lowest detectable concentration is 20 μM with the naked eye and 2.16 μM for UV-vis absorption spectroscopy. A good linear relationship (R2 = 0.9931) between the absorption intensity ratio and K+ concentration (0-100 μM) indicates that this colorimetric probe can be used to detect K+. The method was also applied for quantitative analysis of K+ in real urine samples with recovery between 116 and 120%.
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Affiliation(s)
- Yufeng Sun
- Faculty of Materials, Metallurgical and Chemistry, Jiangxi University of Science and Technology, Ganzhou 341000, China. .,Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China. .,Advanced Energy Science and Technology Guangdong Laboratory, Huizhou 516000, China
| | - Shengwen Wang
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China.
| | - Fangfang Wang
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China.
| | - Hao Zhang
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China.
| | - Weiya Huang
- Faculty of Materials, Metallurgical and Chemistry, Jiangxi University of Science and Technology, Ganzhou 341000, China.
| | - Aiguo Wu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China. .,Advanced Energy Science and Technology Guangdong Laboratory, Huizhou 516000, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yujie Zhang
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo 315201, China. .,Advanced Energy Science and Technology Guangdong Laboratory, Huizhou 516000, China.,University of Chinese Academy of Sciences, Beijing 100049, China
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Challenges of Diagnosing Pseudohypoaldosteronism (PHA) in an Infant. Case Rep Endocrinol 2022; 2022:9921003. [PMID: 35859812 PMCID: PMC9293553 DOI: 10.1155/2022/9921003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Pseudohypoaldosteronism (PHA) is characterized by renal tubular resistance to aldosterone. As a result, the symptoms typically involve hyperkalemia and hyponatremia. The aim of this clinical case report is to highlight the severe electrolyte imbalance PHA can present within an infant, as well as difficulties in diagnosing the condition. Case Presentation. A 5-week-old male arrived at the ER with episodes of emesis, lethargy, and difficulty in feeding. He had significant electrolyte abnormalities and was being treated by his PCP for failure to thrive. He presented with urinary sodium wasting, indicated by hyponatremia, hyperkalemia, low chloride, and hypercalcemia. Patient was treated with IVF and NaCl supplementation to normalize the electrolytes. The patient showed heterozygosity for a variant in the WNK1 gene, which typically causes Gordon syndrome; however, our patient had a normal blood pressure. The electrolyte imbalance self-resolved during several months of follow-up, and currently, the patient is not on any treatment.
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Etges A, Hellmig N, Walenda G, Haddad BG, Machtens JP, Morosan T, Rump LC, Scholl UI. A Novel Homozygous KLHL3 Mutation as a Cause of Autosomal Recessive Pseudohypoaldosteronism Type II Diagnosed Late in Life. Nephron Clin Pract 2022; 146:418-428. [PMID: 35093948 PMCID: PMC9393831 DOI: 10.1159/000521626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Pseudohypoaldosteronism type II (PHA II) is a Mendelian disorder, featuring hyperkalemic acidosis and low plasma renin levels, typically associated with hypertension. Mutations in WNK1, WNK4, CUL3, and KLHL3 cause PHA II, with dominant mutations in WNK1, WNK4, and CUL3 and either dominant or recessive mutations in KLHL3. Fourteen families with recessive KLHL3 mutations have been reported, with diagnosis at the age of 3 months to 56 years, typically in individuals with normal kidney function. Methods We performed clinical and genetic investigations in a patient with hyperkalemic hypertension and used molecular dynamics simulations, heterologous expression in COS7 cells, and Western blotting to investigate the effect of a KLHL3 candidate disease mutation on WNK4 protein expression. Results The patient, a 58-year-old woman from a consanguineous family, showed hypertension, persistent hyperkalemic acidosis associated with severe muscle pain, nephrolithiasis, chronic kidney disease (CKD), and coronary heart disease. Therapy with hydrochlorothiazide corrected hyperkalemia, hypertension, and muscle pain. Genetic analysis revealed a homozygous p.Arg431Trp mutation at a highly conserved KLHL3 position. Simulations suggested reduced stability of the mutant protein, which was confirmed by Western blot. Compared with wild-type KLHL3, cotransfection of p.Arg431Trp KLHL3 led to increased WNK4 protein levels, inferred to cause increased NaCl reabsorption via the thiazide-sensitive carrier and PHA II. Conclusions Even in patients presenting late in life and in the presence of CKD, PHA II should be suspected if renin levels are low and hyperkalemic acidosis and hypertension are inadequate for CKD stage, particularly in the presence of a suspicious family history.
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Affiliation(s)
- Annika Etges
- Department of Nephrology, School of Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Nicole Hellmig
- Department of Nephrology and Medical Intensive Care, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
| | - Gudrun Walenda
- Department of Nephrology, School of Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Bassam G. Haddad
- Institute of Biological Information Processing (IBI-1), Molekular- und Zellphysiologie, and JARA-HPC, Forschungszentrum Jülich, Jülich, Germany
| | - Jan-Philipp Machtens
- Institute of Biological Information Processing (IBI-1), Molekular- und Zellphysiologie, and JARA-HPC, Forschungszentrum Jülich, Jülich, Germany
- Institute of Clinical Pharmacology, RWTH Aachen University, Aachen, Germany
| | | | - Lars Christian Rump
- Department of Nephrology, School of Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ute I. Scholl
- Department of Nephrology, School of Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
- Department of Nephrology and Medical Intensive Care, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
- *Ute I. Scholl,
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Hureaux M, Mazurkiewicz S, Boccio V, Vargas-Poussou R, Jeunemaitre X. The variety of genetic defects explains the phenotypic heterogeneity of Familial Hyperkalemic Hypertension. Kidney Int Rep 2021; 6:2639-2652. [PMID: 34622103 PMCID: PMC8484123 DOI: 10.1016/j.ekir.2021.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Familial hyperkalemic hypertension is a rare inherited form of arterial hypertension. Four genes are responsible for this disease, the variants of these genes cause disruption in the regulation of ion transport in the distal renal tubule. Whether the genotype explains the large phenotypic heterogeneity has not been fully explored. Methods We retrospectively analyzed clinical and genetic data of 153 cases (84 probands, 69 relatives) with familial hyperkalemic hypertension. Results Pathogenic variants (25 novel variants) were identified as follows: KLHL3 (n = 50), CUL3 (n = 16), WNK1 acidic motif (n = 11), WNK4 acidic motif (n = 4) and WNK1 intron 1 deletions (n = 3). De novo cases were mainly observed in the CUL3-related cases (9 of 12) and recessive cases were only observed in KLHL3-related cases (14 of 50). More severe forms were observed in recessive KLHL3 and CUL3 cases that were also associated with growth retardation. Patients with WNK1 acidic motif variants had a typical biological phenotype and lower frequency of hypertension conversely to WNK4 variants affecting the same motif. Patients with heterozygous KLHL3 and WNK1 deletions had milder forms. Familial screening in 178 relatives allowed detection and care for 69 positive cases. Blood pressure and hyperkalemia were improved by hydrochlorothiazide in all groups. Conclusions This study confirms the phenotypic variability ranging from the severe and early forms associated with CUL3 and recessive KLHL3 genotypes through intermediate forms associated with KLHL3 dominant, WNK4 and WNK1 deletion to mild form associated with WNK1 acidic motif genotype and reinforces the interest of genetic screening to better orientate medical care and genetic counseling.
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Affiliation(s)
- Marguerite Hureaux
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique et Centre de Référence des Maladies Rénales Héréditaires Rares (MARHEA), Paris, France
| | | | - Valerie Boccio
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique et Centre de Référence des Maladies Rénales Héréditaires Rares (MARHEA), Paris, France
| | - Rosa Vargas-Poussou
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique et Centre de Référence des Maladies Rénales Héréditaires Rares (MARHEA), Paris, France
| | - Xavier Jeunemaitre
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique et Centre de Référence des Maladies Rénales Héréditaires Rares (MARHEA), Paris, France
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Weiner ID, Verlander JW. Emerging Features of Ammonia Metabolism and Transport in Acid-Base Balance. Semin Nephrol 2020; 39:394-405. [PMID: 31300094 DOI: 10.1016/j.semnephrol.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ammonia metabolism has a critical role in acid-base homeostasis and in other cellular functions. Kidneys have a central role in bicarbonate generation, which occurs through the process of net acid excretion; ammonia metabolism is the quantitatively greatest component of net acid excretion, both under basal conditions and in response to acid-base disturbances. Several recent studies have advanced our understanding substantially of the molecular mechanisms and regulation of ammonia metabolism. First, the previous paradigm that ammonia transport could be explained by passive NH3 diffusion and NH4+ trapping has been advanced by the recognition that specific transport of NH3 and of NH4+ by specific membrane proteins is critical to ammonia transport. Second, significant advances have been made in the understanding of the regulation of ammonia metabolism. Novel studies have shown that hyperkalemia directly inhibits ammonia metabolism, thereby leading to the metabolic acidosis present in type IV renal tubular acidosis. Other studies have shown that the proximal tubule protein NBCe1, specifically the A variant NBCe1-A, has a major role in regulating renal ammonia metabolism. Third, there are important sex differences in ammonia metabolism that involve structural and functional differences in the kidney. This review addresses these important aspects of ammonia metabolism and transport.
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Affiliation(s)
- I David Weiner
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL; Nephrology and Hypertension Section, Gainesville Veterans Affairs Medical Center, Gainesville, FL.
| | - Jill W Verlander
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
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8
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Mabillard H, Sayer JA. The Molecular Genetics of Gordon Syndrome. Genes (Basel) 2019; 10:genes10120986. [PMID: 31795491 PMCID: PMC6947027 DOI: 10.3390/genes10120986] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
Gordon syndrome is a rare inherited monogenic form of hypertension, which is associated with hyperkalaemia and metabolic acidosis. Since the recognition of this predominantly autosomal dominant condition in the 1960s, the study of families with Gordon syndrome has revealed four genes WNK1, WNK4, KLHL3, and CUL3 to be implicated in its pathogenesis after a phenotype–genotype correlation was realised. The encoded proteins Kelch-like 3 and Cullin 3 interact to form a ring-like complex to ubiquitinate WNK-kinase 4, which, in normal circumstances, interacts with the sodium chloride co-symporter (NCC), the epithelial sodium channel (ENaC), and the renal outer medullary potassium channel (ROMK) in an inhibitory manner to maintain normokalaemia and normotension. WNK-kinase 1 has an inhibitory action on WNK-kinase 4. Mutations in WNK1, WNK4, KLHL3, and CUL3 all result in the accumulation of WNK-kinase 4 and subsequent hypertension, hyperkalaemia, and metabolic acidosis. This review explains the clinical aspects, disease mechanisms, and molecular genetics of Gordon syndrome.
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Affiliation(s)
- Holly Mabillard
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
| | - John A. Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Correspondence: ; Tel.: +44-191-2418608
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Naderi M, Hosseini M, Ganjali MR. Naked-eye detection of potassium ions in a novel gold nanoparticle aggregation-based aptasensor. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 195:75-83. [PMID: 29414585 DOI: 10.1016/j.saa.2018.01.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 05/27/2023]
Abstract
In this work, we studied the feasibility of interaction among gold nanoparticles (AuNPs) and a cationic dye in an aptasensor system for the detection of potassium ions. The presence and absence of potassium in the solution was distinguishable by different colors (between orange and green) appeared after reaction. Cationic dye (Y5GL) acts as a new aggregator for AuNP-based sensors which changes the aggregated AuNP solution color from blue-purple to green. In the presence of K+ ions, the aptamer dissociated from the surface of the AuNP so that free AuNPs and cationic dye make the solution green. The aptasensor showed that the analytical linear range was from 10 nM to 50 mM and the detection limit was 4.4 nM. Also, we examined the practicality of this method on a simple paper based platform. The linear range of the colorimetric paper sensor covered of K+ concentration from 10 μM to 40 mM and the detection limit of 6.2 μM was obtained. The selectivity of AuNP aggregation-based sensor improved by the use of cationic dye. Rapidity, simplicity, high sensitivity and excellent selectivity made this assay suitable for practical determination of K+ in real urine samples.
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Affiliation(s)
- Mahboube Naderi
- Department of Life Science Engineering, Faculty of New Sciences & Technologies, University of Tehran, Tehran, Iran
| | - Morteza Hosseini
- Department of Life Science Engineering, Faculty of New Sciences & Technologies, University of Tehran, Tehran, Iran; Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Ganjali
- Center of Excellence in Electrochemistry, Faculty of Chemistry, University of Tehran, Tehran, Iran; Biosensor Research Center, Endocrinology & Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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10
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Harris AN, Grimm PR, Lee HW, Delpire E, Fang L, Verlander JW, Welling PA, Weiner ID. Mechanism of Hyperkalemia-Induced Metabolic Acidosis. J Am Soc Nephrol 2018; 29:1411-1425. [PMID: 29483157 DOI: 10.1681/asn.2017111163] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background Hyperkalemia in association with metabolic acidosis that are out of proportion to changes in glomerular filtration rate defines type 4 renal tubular acidosis (RTA), the most common RTA observed, but the molecular mechanisms underlying the associated metabolic acidosis are incompletely understood. We sought to determine whether hyperkalemia directly causes metabolic acidosis and, if so, the mechanisms through which this occurs.Methods We studied a genetic model of hyperkalemia that results from early distal convoluted tubule (DCT)-specific overexpression of constitutively active Ste20/SPS1-related proline-alanine-rich kinase (DCT-CA-SPAK).Results DCT-CA-SPAK mice developed hyperkalemia in association with metabolic acidosis and suppressed ammonia excretion; however, titratable acid excretion and urine pH were unchanged compared with those in wild-type mice. Abnormal ammonia excretion in DCT-CA-SPAK mice associated with decreased proximal tubule expression of the ammonia-generating enzymes phosphate-dependent glutaminase and phosphoenolpyruvate carboxykinase and overexpression of the ammonia-recycling enzyme glutamine synthetase. These mice also had decreased expression of the ammonia transporter family member Rhcg and decreased apical polarization of H+-ATPase in the inner stripe of the outer medullary collecting duct. Correcting the hyperkalemia by treatment with hydrochlorothiazide corrected the metabolic acidosis, increased ammonia excretion, and normalized ammoniagenic enzyme and Rhcg expression in DCT-CA-SPAK mice. In wild-type mice, induction of hyperkalemia by administration of the epithelial sodium channel blocker benzamil caused hyperkalemia and suppressed ammonia excretion.Conclusions Hyperkalemia decreases proximal tubule ammonia generation and collecting duct ammonia transport, leading to impaired ammonia excretion that causes metabolic acidosis.
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Affiliation(s)
- Autumn N Harris
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - P Richard Grimm
- Department of Physiology and Maryland Center for Kidney Discovery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hyun-Wook Lee
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Lijuan Fang
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Jill W Verlander
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Paul A Welling
- Department of Physiology and Maryland Center for Kidney Discovery, University of Maryland School of Medicine, Baltimore, Maryland
| | - I David Weiner
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida; .,Nephrology and Hypertension Section, Gainesville Veterans Administration Medical Center, Gainesville, Florida
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11
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Burrello J, Monticone S, Buffolo F, Tetti M, Veglio F, Williams TA, Mulatero P. Is There a Role for Genomics in the Management of Hypertension? Int J Mol Sci 2017; 18:ijms18061131. [PMID: 28587112 PMCID: PMC5485955 DOI: 10.3390/ijms18061131] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/20/2017] [Accepted: 05/21/2017] [Indexed: 12/13/2022] Open
Abstract
Hypertension (HTN) affects about 1 billion people worldwide and the lack of a single identifiable cause complicates its treatment. Blood pressure (BP) levels are influenced by environmental factors, but there is a strong genetic component. Linkage analysis has identified several genes involved in Mendelian forms of HTN and the associated pathophysiological mechanisms have been unravelled, leading to targeted therapies. The majority of these syndromes are due to gain-of-function or loss-of-functions mutations, resulting in an alteration of mineralocorticoid, glucocorticoid, or sympathetic pathways. The diagnosis of monogenic forms of HTN has limited practical implications on the population and a systematic genetic screening is not justifiable. Genome-wide linkage and association studies (GWAS) have identified single nucleotide polymorphisms (SNPs), which influence BP. Forty-three variants have been described with each SNP affecting systolic and diastolic BP by 1.0 and 0.5 mmHg, respectively. Taken together Mendelian inheritance and all GWAS-identified HTN-associated variants explain 2–3% of BP variance. Epigenetic modifications, such as DNA methylation, histone modification and non-coding RNAs, have become increasingly recognized as important players in BP regulation and may justify a further part of missing heritability. In this review, we will discuss how genetics and genomics may assist clinicians in managing patients with HTN.
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Affiliation(s)
- Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
| | - Fabrizio Buffolo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
| | - Martina Tetti
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
| | - Tracy A Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, 80336 Munich, Germany.
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
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Tutakhel OAZ, Moes AD, Valdez-Flores MA, Kortenoeven MLA, Vrie MVD, Jeleń S, Fenton RA, Zietse R, Hoenderop JGJ, Hoorn EJ, Hilbrands L, Bindels RJM. NaCl cotransporter abundance in urinary vesicles is increased by calcineurin inhibitors and predicts thiazide sensitivity. PLoS One 2017; 12:e0176220. [PMID: 28430812 PMCID: PMC5400280 DOI: 10.1371/journal.pone.0176220] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/08/2017] [Indexed: 11/30/2022] Open
Abstract
Animal studies have shown that the calcineurin inhibitors (CNIs) cyclosporine and tacrolimus can activate the thiazide-sensitive NaCl cotransporter (NCC). A common side effect of CNIs is hypertension. Renal salt transporters such as NCC are excreted in urinary extracellular vesicles (uEVs) after internalization into multivesicular bodies. Human studies indicate that CNIs also increase NCC abundance in uEVs, but results are conflicting and no relationship with NCC function has been shown. Therefore, we investigated the effects of CsA and Tac on the abundance of both total NCC (tNCC) and phosphorylated NCC at Thr60 phosphorylation site (pNCC) in uEVs, and assessed whether NCC abundance in uEVs predicts the blood pressure response to thiazide diuretics. Our results show that in kidney transplant recipients treated with cyclosporine (n = 9) or tacrolimus (n = 23), the abundance of both tNCC and pNCC in uEVs is 4–5 fold higher than in CNI-free kidney transplant recipients (n = 13) or healthy volunteers (n = 6). In hypertensive kidney transplant recipients, higher abundances of tNCC and pNCC prior to treatment with thiazides predicted the blood pressure response to thiazides. During thiazide treatment, the abundance of pNCC in uEVs increased in responders (n = 10), but markedly decreased in non-responders (n = 8). Thus, our results show that CNIs increase the abundance of both tNCC and pNCC in uEVs, and these increases correlate with the blood pressure response to thiazides. This implies that assessment of NCC in uEVs could represent an alternate method to guide anti-hypertensive therapy in kidney transplant recipients.
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Affiliation(s)
- Omar A. Z. Tutakhel
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Arthur D. Moes
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco A. Valdez-Flores
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Programa Regional en Doctorado en Biotecnología, Universidad Autónoma de Sinaloa, Sinaloa, Mexico
| | - Marleen L. A. Kortenoeven
- Department of Biomedicine, Center for Interaction of Proteins in Epithelial Transport, Aarhus University, Aarhus, Denmark
| | - Mathijs v. D. Vrie
- Department of Nephrology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Sabina Jeleń
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Robert A. Fenton
- Department of Biomedicine, Center for Interaction of Proteins in Epithelial Transport, Aarhus University, Aarhus, Denmark
| | - Robert Zietse
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost G. J. Hoenderop
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Ewout J. Hoorn
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Luuk Hilbrands
- Department of Nephrology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - René J. M. Bindels
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- * E-mail:
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Affiliation(s)
- John K. Healy
- From the Princess Alexandra Hospital Brisbane, Brisbane, Queensland, Australia; and Renal Unit, Royal Brisbane Hospital, Brisbane, Queensland, Australia
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14
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Seidowsky A, Moulonguet-Doleris L, Hanslik T, Yattara H, Ayari H, Rouveix E, Massy ZA, Prinseau J. [Tubular renal acidosis]. Rev Med Interne 2013; 35:45-55. [PMID: 24070792 DOI: 10.1016/j.revmed.2013.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 07/25/2013] [Accepted: 08/17/2013] [Indexed: 11/30/2022]
Abstract
Renal tubular acidosis (RTAs) are a group of metabolic disorders characterized by metabolic acidosis with normal plasma anion gap. There are three main forms of RTA: a proximal RTA called type II and a distal RTA (type I and IV). The RTA type II is a consequence of the inability of the proximal tubule to reabsorb bicarbonate. The distal RTA is associated with the inability to excrete the daily acid load and may be associated with hyperkalaemia (type IV) or hypokalemia (type I). The most common etiology of RTA type IV is the hypoaldosteronism. The RTAs can be complicated by nephrocalcinosis and obstructive nephrolithiasis. Alkalinization is the cornerstone of treatment.
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Affiliation(s)
- A Seidowsky
- Université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France; Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France.
| | - L Moulonguet-Doleris
- Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - T Hanslik
- Université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - H Yattara
- Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - H Ayari
- Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - E Rouveix
- Université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - Z A Massy
- Université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
| | - J Prinseau
- Université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Service de néphrologie, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt cedex, France
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15
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Pela I. Familial Hyperkalemic Hypertension: A New Early-onset Pediatric Case. Clin Pediatr Endocrinol 2012; 21:5-9. [PMID: 23926404 PMCID: PMC3687646 DOI: 10.1297/cpe.21.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 11/15/2011] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ivana Pela
- Department of Sciences for Woman and Child's Health, University of Florence, Florence, Italy
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16
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Stowasser M, Pimenta E, Gordon RD. Familial or genetic primary aldosteronism and Gordon syndrome. Endocrinol Metab Clin North Am 2011; 40:343-68, viii. [PMID: 21565671 DOI: 10.1016/j.ecl.2011.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Salt-sensitive forms of hypertension have received considerable renewed attention in recent years. This article focuses on 2 main forms of salt-sensitive hypertension (familial or genetic primary aldosteronism [PA] and Gordon syndrome) and the current state of knowledge regarding their genetic bases. The glucocorticoid-remediable form of familial PA (familial hyperaldosteronism type I) is dealt with only briefly because it is covered in depth elsewhere.
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Affiliation(s)
- Michael Stowasser
- Endocrine Hypertension Research Center, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102, Australia.
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17
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Distal potassium handling based on flow modulation of maxi-K channel activity. Curr Opin Nephrol Hypertens 2009; 18:350-5. [PMID: 19448535 DOI: 10.1097/mnh.0b013e32832c75d8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Studies on the mechanisms of distal K+ secretion have highlighted the importance of the renal outer-medullary K+ (ROMK) and maxi-K channels. This review considers several human disorders characterized by hypokalemia and hyperkalemia, as well as mouse models of these disorders, and the mechanisms by which ROMK and maxi-K may be dysregulated. RECENT FINDINGS Analysis of knockout mice lacking ROMK, a model for type II Bartter's syndrome, has shown a role for maxi-K in distal K+ secretion. Knockout mice lacking either the alpha or beta1 subunits of maxi-K also show deficits in flow-dependent K+ secretion. Analysis of transgenic and knock-in mouse models of pseudohypoaldosteronism type II, in which mutant forms of with-no-lysine kinase 4 are expressed, suggests ways in which ROMK and maxi-K may be dysregulated to result in hyperkalemia. Modeling studies also provide insights into the role of Na+ delivery vs. flow in K+ secretion. SUMMARY The importance of both ROMK and maxi-K to distal K+ secretion is now well established, but the relative role that each of these two channels plays in normal and diseased states has not been definitively established. Analysis of human and animal model data can generate hypotheses for future experiments.
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Proctor G, Linas S. Type 2 pseudohypoaldosteronism: new insights into renal potassium, sodium, and chloride handling. Am J Kidney Dis 2006; 48:674-93. [PMID: 16997066 DOI: 10.1053/j.ajkd.2006.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 06/12/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory Proctor
- Division of Nephrology, University of Colorado Health Sciences Center, Denver, CO, USA.
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20
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Xie J, Craig L, Cobb MH, Huang CL. Role of with-no-lysine [K] kinases in the pathogenesis of Gordon's syndrome. Pediatr Nephrol 2006; 21:1231-6. [PMID: 16683163 DOI: 10.1007/s00467-006-0106-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 01/23/2006] [Indexed: 11/28/2022]
Abstract
Gordon's syndrome, also known as pseudohypoaldosteronism type II (PHA II) or familial hypertension with hyperkalemia, is an autosomal-dominant disease characterized by hypertension, hyperkalemia, hyperchloremic metabolic acidosis, and normal glomerular filtration rate. Recent positional cloning has linked mutations of WNK1 and WNK4 to Gordon's syndrome. With-no-lysine [K] (WNK) kinases are a new family of large serine-threonine protein kinases with an atypical placement of the catalytic lysine. Here, we review the pathogenesis of PHA II based on current understanding of the actions of WNK1 and WNK4 on Na+ and K+ handling in the renal distal tubule.
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Affiliation(s)
- Jian Xie
- Department of Medicine, Room J5-104, MC-8856, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8856, USA
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21
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Hadchouel J, Delaloy C, Fauré S, Achard JM, Jeunemaitre X. Familial Hyperkalemic Hypertension. J Am Soc Nephrol 2005; 17:208-17. [PMID: 16221868 DOI: 10.1681/asn.2005030314] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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22
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Gamba G. Molecular Physiology and Pathophysiology of Electroneutral Cation-Chloride Cotransporters. Physiol Rev 2005; 85:423-93. [PMID: 15788703 DOI: 10.1152/physrev.00011.2004] [Citation(s) in RCA: 572] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Electroneutral cation-Cl−cotransporters compose a family of solute carriers in which cation (Na+or K+) movement through the plasma membrane is always accompanied by Cl−in a 1:1 stoichiometry. Seven well-characterized members include one gene encoding the thiazide-sensitive Na+−Cl−cotransporter, two genes encoding loop diuretic-sensitive Na+−K+−2Cl−cotransporters, and four genes encoding K+−Cl−cotransporters. These membrane proteins are involved in several physiological activities including transepithelial ion absorption and secretion, cell volume regulation, and setting intracellular Cl−concentration below or above its electrochemical potential equilibrium. In addition, members of this family play an important role in cardiovascular and neuronal pharmacology and pathophysiology. Some of these cotransporters serve as targets for loop diuretics and thiazide-type diuretics, which are among the most commonly prescribed drugs in the world, and inactivating mutations of three members of the family cause inherited diseases such as Bartter's, Gitelman's, and Anderman's diseases. Major advances have been made in the past decade as consequences of molecular identification of all members in this family. This work is a comprehensive review of the knowledge that has evolved in this area and includes molecular biology of each gene, functional properties of identified cotransporters, structure-function relationships, and physiological and pathophysiological roles of each cotransporter.
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Affiliation(s)
- Gerardo Gamba
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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23
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Gamba G. Role of WNK kinases in regulating tubular salt and potassium transport and in the development of hypertension. Am J Physiol Renal Physiol 2005; 288:F245-52. [PMID: 15637347 DOI: 10.1152/ajprenal.00311.2004] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A recently discovered family of protein kinases is responsible for an autosomal-dominant disease known as Gordon's syndrome or pseudohypoaldosteronism type II (PHA-II) that features hyperkalemia and hyperchloremic metabolic acidosis, accompanied by hypertension and hypercalciuria. Four genes have been described in this kinase family, which has been named WNK, due to the absence of a key lysine in kinase subdomain II (with no K kinases). Two of these genes, WNK1 and WNK4 located in human chromosomes 12 and 17, respectively, are responsible for PHA-II. Immunohystochemical analysis revealed that WNK1 and WNK4 are predominantly expressed in the distal convoluted tubule and collecting duct. The physiological studies have shown that WNK4 downregulates the activity of ion transport pathways expressed in these nephron segments, such as the apical thiazide-sensitive Na+-Cl−cotransporter and apical secretory K+channel ROMK, as well as upregulates paracellular chloride transport and phosphorylation of tight junction proteins such as claudins. In addition, WNK4 downregulates other Cl−influx pathways such as the basolateral Na+-K+-2Cl−cotransporter and Cl−/HCO3−exchanger. WNK4 mutations behave as a loss of function for the Na+-Cl−cotransporter and a gain of function when it comes to ROMK and claudins. These dual effects of WNK4 mutations fit with proposed mechanisms for developing electrolyte abnormalities and hypertension in PHA-II and point to WNK4 as a multifunctional regulator of diverse ion transporters.
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Affiliation(s)
- Gerardo Gamba
- Molecular Physiology Unit, Instituto de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, México City, Mexico.
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24
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Abstract
Authors describe a case of syndrome of Gordon, a rare genetic disease characterized by hypertension, hyperkalemia and normal glomerular filtration rate. The potential causes of disease are discussed and literature data are reviewed.
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Affiliation(s)
- C M Bruno
- Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
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25
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Abstract
There has been a dramatic recent increase in the understanding of the renal epithelial transport systems with the identification, cloning and characterization of a large number of membrane transport proteins. The aim of this chapter is to integrate this body of knowledge with the understanding of the clinical disorders that accompany gain, loss or dysregulation of function of these transport systems. The specific focus is on the best-defined human clinical syndromes in which there are derangements in potassium (K(+)) homeostasis. The focus is on inherited syndromes, rather than on acquired syndromes due to tubular transport defects, and the therapeutic approaches address chronic derangements of K(+) homeostasis rather than acute interventions directed at life-threatening hyperkalaemia.
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Affiliation(s)
- David G Warnock
- Division of Nephrology, Departments of Medicine and Physiology, Nephrology Research and Training Center, University of Alabama at Birmingham, 647 THT, 1530 3rd Avenue South, Birmingham, AL 35294-0006, USA.
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Faure S, Delaloy C, Leprivey V, Hadchouel J, Warnock DG, Jeunemaitre X, Achard JM. WNK kinases, distal tubular ion handling and hypertension. Nephrol Dial Transplant 2003; 18:2463-7. [PMID: 14605263 DOI: 10.1093/ndt/gfg426] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sebastien Faure
- Division of Nephrology and Department of Physiology, Limoges University Hospital, CHU Depuytren, 87042 Limoges, France
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27
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Achard JM, Warnock DG, Disse-Nicodème S, Fiquet-Kempf B, Corvol P, Fournier A, Jeunemaitre X. Familial hyperkalemic hypertension: phenotypic analysis in a large family with the WNK1 deletion mutation. Am J Med 2003; 114:495-8. [PMID: 12727582 DOI: 10.1016/s0002-9343(03)00054-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Abstract
The recent knowledge of the renal epithelial transport systems has exploded with the identification, cloning, and characterization of a large number of membrane transport proteins. The fundamental aspects of these transporters are beginning to emerge at the molecular level and are summarized in the accompanying contributions in this volume of the Annual Review of Physiology. The aim of my review is to integrate this body of knowledge with the understanding of the clinical disorders of human mineral homeostasis that accompany gain, loss, or dysregulation of function of these transport systems. The specific focus is on the best defined human clinical syndromes in which there are derangements in K(+) and Mg(2+) homeostasis.
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Affiliation(s)
- David G Warnock
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, 35294, USA.
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29
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Achard JM, Disse-Nicodeme S, Fiquet-Kempf B, Jeunemaitre X. Phenotypic and genetic heterogeneity of familial hyperkalaemic hypertension (Gordon syndrome). Clin Exp Pharmacol Physiol 2001; 28:1048-52. [PMID: 11903313 DOI: 10.1046/j.1440-1681.2001.03575.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Familial hyperkalaemic hypertension (FHH), also called pseudohypoaldosteronism type II (PHA2) or Gordon syndrome, is a rare Mendelian-form of low-renin hypertension. The first cases of FHH were reported approximately 30 years ago and they described the peculiar biochemical abnormalities (i.e. hyperkalaemia and hyperchloraemic acidosis despite a normal glomerular filtration rate). 2. Since then, more than 90 single cases and families have been reported in the literature. These various reports show marked differences in phenotype. 3. Our group has now collected 14 unrelated pedigrees originating from different parts of France and Europe. We confirm the large variations in the age of discovery and in the severity of the biochemical abnormalities from one individual to another and from one family to another one. 4. Blood pressure levels have no significant relationship with hyperkalaemia or hyperchloraemia, but there is a positive relationship with age, as in the normal population. 5. Analyses of clinical features and Mendelian segregation in our families demonstrate autosomal-dominant inheritance, as expected from the literature. 6. Efforts have been made in the past years to unravel the gene responsible for the disease. Until now, a primary responsibility of the gene encoding the thiazide-sensitive Na-Cl cotransporter (SLC12A3) has been excluded in PHA2 families. Three loci have been identified on chromosomes 1 (PHA2A), 17 (PHA2B) and 12 (PHA2C). 7. More recently, analysis of three additional pedigrees, including 10 affected subjects, with over 25 members allowed us to demonstrate further genetic heterogeneity and the existence of at least a fourth locus. 8. The genetic heterogeneity of this syndrome, and thus the variety of molecular defects, suggests the role of either several new components of the same pathway, multiple aldosterone- regulated effectors or direct or indirect partners of the Na-Cl cotransporter.
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Affiliation(s)
- J M Achard
- Department of Physiology, Hôpital de Limoges, Limoges, France
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30
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Disse-Nicodeme S, Desitter I, Fiquet-Kempf B, Houot AM, Stern N, Delahousse M, Potier J, Ader JL, Jeunemaitre X. Genetic heterogeneity of familial hyperkalaemic hypertension. J Hypertens 2001; 19:1957-64. [PMID: 11677360 DOI: 10.1097/00004872-200111000-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Familial hyperkalaemic hypertension (FHH) is a Mendelian form of low-renin hypertension characterized by hyperkalaemia and hyperchloraemic acidosis despite a normal glomerular filtration rate. To date, three different loci have been identified, on chromosomes 1, 17 and 12. OBJECTIVE To test for genetic linkage between the three FHH loci and three new affected kindreds. DESIGN AND METHODS Clinical, biological and genetic analyses were made of three kindreds, including 11 affected individuals among 25 members. Genotyping was performed using four series of microsatellite markers spanning the chromosomes 1, 17 and 12 loci, and the thiazide-sensitive Na-Cl cotransporter (SLC12A3) gene. RESULTS Segregation of the trait in each kindred was compatible with an autosomal transmission, the affected individuals displaying reasonably consistent biochemical abnormalities and the expected variability in arterial hypertension. Multipoint linkage analysis excluded linkage with the four candidate loci in kindreds 1 and 2, but not with the chromosome 1 locus in kindred 3. CONCLUSION These results demonstrate further genetic heterogeneity and that a fourth gene is responsible for FHH in at least two unrelated kindreds. They suggest a variety of molecular defects leading to FHH.
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31
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Disse-Nicodème S, Achard JM, Desitter I, Houot AM, Fournier A, Corvol P, Jeunemaitre X. A new locus on chromosome 12p13.3 for pseudohypoaldosteronism type II, an autosomal dominant form of hypertension. Am J Hum Genet 2000; 67:302-10. [PMID: 10869238 PMCID: PMC1287179 DOI: 10.1086/303020] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2000] [Accepted: 05/24/2000] [Indexed: 11/03/2022] Open
Abstract
Pseudohypoaldosteronism type II (PHA2) is a rare autosomal dominant form of volume-dependent low-renin hypertension characterized by hyperkalemia and hyperchloremic acidosis but also by a normal glomerular filtration rate. These features, together with the correction of blood pressure and metabolic abnormalities by small doses of thiazide diuretics, suggest a primary renal tubular defect. Two loci have previously been mapped at low resolution to chromosome 1q31-42 (PHA2A) and 17p11-q21 (PHA2B). We have now analyzed a new, large French pedigree, in which 12 affected members over three generations confirmed the autosomal dominant inheritance. Affected subjects had hypertension together with long-term hyperkalemia (range 5.2-6.2 mmol/liter), hyperchloremia (range: 100-109 mmol/liter), normal plasma creatinine (range: 63-129 mmol/liter) and low renin levels. Genetic linkage was excluded for both PHA2A and PHA2B loci (all LOD scores Z<-3.2 at recombination fraction [theta] 0), as well as for the thiazide-sensitive sodium-chloride cotransporter gene. A genome-wide scan using 383 microsatellite markers showed a strong linkage with the chromosome 12p13 region (maximum LOD score Z=6.18, straight theta=0, at D12S99). Haplotype analysis using 10 additional polymorphic markers led to a minimum 13-cM interval flanked by D12S1652 and D12S336, thus defining a new PHA2C locus. Analysis of two obvious candidate genes (SCNN1A and GNb3) located within the interval showed no deleterious mutation. In conclusion, we hereby demonstrate further genetic heterogeneity of this Mendelian form of hypertension and identify a new PHA2C locus, the most compelling and precise linkage interval described to date.
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Affiliation(s)
- Sandra Disse-Nicodème
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Jean-Michel Achard
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Isabelle Desitter
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Anne-Marie Houot
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Albert Fournier
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Pierre Corvol
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
| | - Xavier Jeunemaitre
- INSERM U36, Collège de France, and Laboratoire de Génétique Moléculaire, Hôpital Broussais, Assistance Publique-Hôpitaux de Paris, Paris; and Service de Néphrologie, Hôpital d’Amiens-Sud, Amiens, France
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Erdoğan G, Corapçioğlu D, Erdoğan MF, Hallioğlu J, Uysal AR. Furosemide and dDAVP for the treatment of pseudohypoaldosteronism type II. J Endocrinol Invest 1997; 20:681-4. [PMID: 9492109 DOI: 10.1007/bf03348032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 27-year-old Turkish male presented with fatigue, long lasting hypertension, hyperkalemia, hyperchloremic metabolic acidosis and normal glomerular filtration rate. His brother also showed hyperkalemia with no other features of the disease. Plasma renin levels were low and serum aldosterone levels were inappropriately low-normal to his hyperkalemia. Plasma cortisol levels were normal. Plasma renin aldosterone levels responded appropriately to postural changes, salt restriction and saline infusion. Fludrocortisone was ineffective in his hyperkalemia. The conditions were consistent with Type II pseudohypoaldosteronism (PHA). Furosemide and sodium bicarbonate were effective to control his hyperchloremia, metabolic acidosis and hypertension but partly effective for his hyperkalemia. dDAVP alone did not control the situation and hypertension and metabolic derangement reoccurred. Adding dDAVP to furosemide and sodium bicarbonate successfully controlled hyperkalemia, hyperchloremic acidosis and hypertension. The patient stayed normotensive with normal metabolic and biochemical parameters after 6 months with furosemide and dADVP although sodium bicarbonate had been discontinued after the first month of therapy. dDAVP is a useful adjunct to furosemide and non chloride anions which altogether successfully reverse the metabolic derangement in Type II PHA.
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Affiliation(s)
- G Erdoğan
- Department of Endocrinology and Metabolism, University of Ankara School of Medicine, Turkey
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Muhammad S, Mamish ZM, Tucci JR. Type II pseudohypoaldosteronism. Report of a case and review of the literature. J Endocrinol Invest 1994; 17:453-7. [PMID: 7930391 DOI: 10.1007/bf03347738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 56-year-old white female presented with longstanding hyperkalemia, hyperchloremia, and hypertension. Renal function was normal. Plasma renin levels were low as were serum and urinary aldosterone. Plasma cortisol levels were normal. Fludrocortisone was ineffective in lowering serum potassium. Plasma renin and aldosterone levels responded appropriately to salt restriction and to postural changes. Plasma atrial natriuretic hormone (ANH) and urinary prostaglandins (PG) were normal. Salt loading resulted in suppression of renin and aldosterone levels and stimulation of plasma ANH and urinary PG but failed to increase potassium or chloride excretion. The persistent hyperkalemia, hyperchloremia, and suppressed renin-aldosterone axis were consistent with type II pseudohypoaldosteronism. Hydrochlorothiazide was effective in normalizing serum potassium levels and blood pressure. These studies exclude abnormalities in ANH and PG secretion in this disorder and are compatible with an abnormality in chloride reabsorption.
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Affiliation(s)
- S Muhammad
- Roger Williams Medical Center, Division of Endocrinology and Metabolism, Brown University School of Medicine, Providence, Rhode Island
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Take C, Ikeda K, Kurasawa T, Kurokawa K. Increased chloride reabsorption as an inherited renal tubular defect in familial type II pseudohypoaldosteronism. N Engl J Med 1991; 324:472-6. [PMID: 1988833 DOI: 10.1056/nejm199102143240707] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Take
- Department of Internal Medicine, Tokyo Kohsei-Nenkin Hospital, Japan
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Affiliation(s)
- N A Kurtzman
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
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Wayne VS, Stockigt JR, Jennings GL. Treatment of mineralocorticoid-resistant renal hyperkalemia with hypertension (type II pseudohypoaldosteronism). AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1986; 16:221-3. [PMID: 3463275 DOI: 10.1111/j.1445-5994.1986.tb01154.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 16 year old girl with the rare syndrome characterised by hypertension, hyperkalemia, and acidosis was treated with a range of drugs, including thiazides, frusemide, and beta-adrenoceptor antagonists. None of the agents normalised the hypertension and biochemical abnormalities. Best results were obtained with methyclothiazide in full dosage, which normalised the blood pressure, serum potassium level, and bicarbonate level in the face of increased plasma renin activity. Empirical treatment with thiazides is the most satisfactory method for long term management.
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37
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Gordon RD. Syndrome of hypertension and hyperkalemia with normal glomerular filtration rate. Hypertension 1986; 8:93-102. [PMID: 3002982 DOI: 10.1161/01.hyp.8.2.93] [Citation(s) in RCA: 169] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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38
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Klaus D. [Primary hypoaldosteronism, pseudo-hypoaldosteronism and distal tubular acidosis]. KLINISCHE WOCHENSCHRIFT 1984; 62:747-52. [PMID: 6384650 DOI: 10.1007/bf01721771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Aldosterone deficiency is caused by various defects of aldosterone biosynthesis in the adrenal gland or hyporeninism. The most important symptoms are hyponatremia and hyperkalemia. These electrolyte disturbances are also found in pseudohypoaldosteronism. Pseudohypoaldosteronism type I is characterized by insensitivity of the distal nephron for aldosterone. Hyperabsorption of chloride in the distal nephron leads to pseudohypoaldosteronism type II, which is linked with hypertension, whereas blood pressure in the other mentioned disorders is decreased. Renal tubular acidosis, mainly type 4, with impaired production of ammonia due to hyperkalemia, is frequently observed in hypoaldosteronism and both types of pseudohypoaldosteronism as well. The therapeutic regimen is different: low doses of fludrocortisone in hypoaldosteronism, potassium restriction, sodium bicarbonate and loop diuretics in type I of pseudohypoaldosteronism, and sodium restriction and chloruretic diuretics (thiazide) in type II of pseudohypoaldosteronism. In some cases hyperkalemia requires the use of potassium-binding resins.
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Klaus D, Lederle RM, Vecsei P. [Primary hypoaldosteronism and secondary pseudo-hypoaldosteronism]. KLINISCHE WOCHENSCHRIFT 1984; 62:753-8. [PMID: 6090761 DOI: 10.1007/bf01721772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We observed a 23-year-old man with pronounced hyperkalemia (max. 6.8 mmol/l) and hyponatremia (min. 112 mmol/l), which had been existent for 3 years without complaint except a transitory psychorganic syndrome due to hyponatremia. Physical examination showed no abnormality except hypotension (blood pressure 100/70 mmHg). Renal function tests were normal. Fractional clearance of sodium was significantly increased (0.8%), whereas that of potassium was decreased (2.4%). Plasma renin activity was tripled and rose after furosemide. Plasma aldosterone was lowered and showed no rise after furosemide. Suppression of plasma renin and aldosterone by saline infusion was normal. Pressor dose of angiotensin II was increased (17,9 ng AT II/kg/min). Urinary excretion of aldosterone and its conjugates was below normal, and aldosterone precursors were within normal range. The findings were interpreted as selective primary hypoaldosteronism caused by corticosterone methyl oxidase defect type II. However, neither fludrocortisone (0.5 mg/day) nor sodium chloride (200 mmol/day) led to a normalization of sodium and potassium in plasma. Additional pseudohypoaldosteronism was thus assumed. Aldosterone infusion (3 mg in 1 h) decreased renal excretion of sodium; potassium excretion failed, however, to increase in contrast to its pattern in normal man. These findings resemble additional pseudohypo-aldosteronism of type II. After 8 weeks' application of additional 80 mmol sodium (as sodium bicarbonate) plasma sodium and potassium showed normal values under combined treatment with fludrocortisone (0.1 mg/day) and sodium bicarbonate (80 mmol/day). It is to be assumed that the patient suffers from a reduced aldosterone biosynthesis in the presence of an additional transitory secondary pseudohypoaldosteronism.
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Agmon D, Green J, Platau E, Better OS. Isolated adrenal mineralocorticoid deficiency due to amyloidosis associated with familial Mediterranean fever. Am J Med Sci 1984; 288:40-3. [PMID: 6465194 DOI: 10.1097/00000441-198407000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A patient with familial Mediterranean fever (FMF) associated with renal amyloidosis, presented with hyperkalemia and acidosis which were excessive to his moderate degree of azotemia. The cause of this abnormality was isolated hypoaldosteronism with otherwise normal adrenal function and tubular capacity to transport potassium. This selective involvement of the zona glomerulosa stands in marked contrast to the usual sparing of the glomerulosa seen in post mortem studies of patients with FMF and amyloidosis reported from this country.
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Abstract
Distal renal tubular acidosis results from ineffective addition of hydrogen ions to the lumen of the distal nephron. The syndrome is manifested by hyperchloremic metabolic acidosis often associated with hypokalemia. More recently, it has been recognized that hyperkalemia rather than hypokalemia can be a dominant feature of some cases of distal renal tubular acidosis. It has been generally accepted that all cases of this syndrome ultimately resulted from a similar mechanism. The prevailing view was that the abnormality underlying distal renal tubular acidosis was that of inability to either generate or maintain a steep pH gradient across the distal nephron. Recent advances in our understanding of the process of distal acidification have provided evidence that different mechanisms can alter distal hydrogen ion secretion. In this article, the significance of the various indices of urinary acidification and their use in the characterization of the mechanism underlying distal renal tubular acidosis are revised. A classification of distal renal tubular acidosis on the basis of mechanism is presented. The importance of plasma potassium and renal potassium excretion in the evaluation of patients with distal renal tubular acidosis is emphasized.
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Schambelan M, Sebastian A, Rector FC. Mineralocorticoid-resistant renal hyperkalemia without salt wasting (type II pseudohypoaldosteronism): role of increased renal chloride reabsorption. Kidney Int 1981; 19:716-27. [PMID: 7026872 DOI: 10.1038/ki.1981.72] [Citation(s) in RCA: 153] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A rare syndrome has been described in which mineralocorticoid-resistant hyperkalemia of renal origin occurs in the absence of glomerular insufficiency and renal sodium wasting and in which hyperchloremic acidosis, hypertension, and hyporeninemia coexist. The primary abnormality has been postulated to be a defect of the potassium secretory mechanism of the distal nephron. The present studies were carried out to investigate the mechanism of impaired renal potassium secretion in a patient with this syndrome. When dietary intake of sodium chloride was normal, renal clearance of potassium was subnormal (CK/GFR = 3.6 +/- 0.2%; normal subjects, 9.0 +/- 0.9%, N = 4) despite high normal or supernormal levels of plasma and urinary aldosterone. The fractional clearance of potassium remained subnormal (CK/GFR = 5.1 +/- 0.2%) during superimposed chronic administration of superphysiologic doses of mineralocorticoid hormone. Little increase in renal potassium clearance occurred when the delivery of sodium to distal nephron segments was increased further by the i.v. infusion of sodium chloride, despite experimentally sustained hypermineralocorticoidism. But potassium clearance increased greatly when delivery of sodium to the distal nephron was increased by infusion of nonchloride anions: sulfate (sodium sulfate infusion, low sodium chloride diet; CK/GFR = 63.7 +/- 0.4%) or bicarbonate (sodium bicarbonate plus acetazolamide infusion; CK/GFR = 81.7 +/- 1.7%). These findings indicate that mineralocorticoid-resistant renal hyperkalemia in this patient cannot be attributed to the absence of a renal potassium secretory capability or to diminished delivery of sodium to distal nephron segments; instead it may be dependent on chloride delivery to the distal nephron. We suggest that the primary abnormality in this syndrome increases the reabsorptive avidity of the distal nephron for chloride, which (1) limits the sodium and mineralocorticoid-dependent voltage driving force for potassium and hydrogen ion secretion, resulting in hyperkalemia and acidosis and (2) augments distal sodium chloride reabsorption resulting in hyperchloremia, volume expansion, hyporeninemia, and hypertension.
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45
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Barratt LJ. Potassium Handling by the Kidney. Hyperkalaemia. Intern Med J 1981. [DOI: 10.1111/j.1445-5994.1981.tb04945.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tormey WP, Morgan DB. Etiological considerations in Gordon's syndrome: possible role of prostaglandins. PROSTAGLANDINS AND MEDICINE 1980; 4:107-12. [PMID: 6994152 DOI: 10.1016/0161-4630(80)90042-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The syndrome of hypertension, low plasma renin and aldosterone and hyperchloraemic acidosis (Gordon's syndrome) may be caused by a switch in the intrarenal synthesis of prostaglandins from PGE2 to PGF2 which results in changes in the renin-angiotensin and in the kallikrein-kinin systems. The role of excess reabsorption of sodium chloride and hypersensitivity of the vasculature to angiotensin II in the genesis of the high blood pressure and of the other metabolic disturbances is discussed.
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47
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DeFronzo RA, Goldberg M, Cooke CR, Barker C, Grossman RA, Agus ZS. Investigations into the mechanisms of hyperkalemia following renal transplantation. Kidney Int 1977; 11:357-65. [PMID: 330924 DOI: 10.1038/ki.1977.53] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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48
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Szylman P, Better OS, Chaimowitz C, Rosler A. Role of hyperkalemia in the metabolic acidosis of isolated hypoaldosteronism. N Engl J Med 1976; 294:361-5. [PMID: 1674 DOI: 10.1056/nejm197602122940703] [Citation(s) in RCA: 89] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We studied the relative importance of hyperkalemia and mineralocorticoid deficiency in the metabolic acidosis of a patient with proved isolated hyporeninemic hypoaldosteronism and moderate kidney failure. The hyperkalemia and acidosis were severe in relation to the slight azotemia. Despite the systemic acidosis and urinary pH of 4.9, urinary ammonium excretion was distinctly blunted. Correction of the hyperkalemia by potassium-sodium exchange resin alone resolved the acidosis and restored the previously diminished urinary ammonium excretion to normal. Administration of mineralocorticoids only partially corrected the hyperkalemia and the acidosis. Hyperkalemia by itself, rather than hypoaldosteronism per se, caused the acidosis in this patient. Hyperkalemia apparently suppresses urinary ammonium excretion and thus interferes with urinary acidification.
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49
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Priest JN, Ahmed M, Nuttall FQ. Pathologic hypofunction of the renin-angiotensin-aldosterone system. Postgrad Med 1976; 59:86-93. [PMID: 1250809 DOI: 10.1080/00325481.1976.11714270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The literature now contains reports of many cases of aldosterone deficiency. Usually, the presenting features are persistent hyperkalemia and tendencies to serious urinary sodium loss and hypotension. A classification of defects leading to pathologic hypofunction of the renin-angiotensin-aldosterone system (RAAS hypofunction) is presented, with emphasis on idiopathic hyporeninemia (probably the most common). Criteria for diagnosis are (1) normal adrenal glucocorticoid function, (2) low aldosterone excretion under basal and stimulated conditions, and (3) renal tubular responsiveness to exogenous mineralocorticoid. The condition is effectively managed with mineralocorticoid replacement therapy and should be considered in the presence of unexplained persistent hyperkalemia, hyponatremia, or postural hypotension.
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Weinstein SF, Allan DM, Mendoza SA. Hyperkalemia, acidosis, and short stature associated with a defect in renal potassium excretion. J Pediatr 1974; 85:355-8. [PMID: 4431495 DOI: 10.1016/s0022-3476(74)80115-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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