Postoperative potassium deficit and metabolic alkalosis; the pathogenic significance of operative trauma and of potassium and phosphorus deprivation

NBCe1-A is required for the renal ammonia and K+ response to hypokalemia

Hypokalemia increases ammonia excretion and decreases K⁺ excretion. The present study examined the role of the proximal tubule protein NBCe1-A in these responses. We studied mice with Na⁺-bicarbonate cotransporter electrogenic, isoform 1, splice variant A (NBCe1-A) deletion [knockout (KO) mice] and their wild-type (WT) littermates were provided either K⁺ control or K⁺-free diet. We also used tissue sections to determine the effect of extracellular ammonia on NaCl cotransporter (NCC) phosphorylation. The K⁺-free diet significantly increased proximal tubule NBCe1-A and ammonia excretion in WT mice, and NBCe1-A deletion blunted the ammonia excretion response. NBCe1-A deletion inhibited the ammoniagenic/ammonia recycling enzyme response in the cortical proximal tubule (PT), where NBCe1-A is present in WT mice. In the outer medulla, where NBCe1-A is not present, the PT ammonia metabolism response was accentuated by NBCe1-A deletion. KO mice developed more severe hypokalemia and had greater urinary K⁺ excretion during the K⁺-free diet than did WT mice. This was associated with blunting of the hypokalemia-induced change in NCC phosphorylation. NBCe1-A KO mice have systemic metabolic acidosis, but experimentally induced metabolic acidosis did not alter NCC phosphorylation. Although KO mice have impaired ammonia metabolism, experiments in tissue sections showed that lack of ammonia does impair NCC phosphorylation. Finally, urinary aldosterone was greater in KO mice than in WT mice, but neither expression of epithelial Na⁺ channel α-, β-, and γ-subunits nor of H⁺-K⁺-ATPase α₁- or α₂-subunits correlated with changes in urinary K⁺. We conclude that NBCe1-A is critical for the effect of diet-induced hypokalemia to increase cortical proximal tubule ammonia generation and for the expected decrease in urinary K⁺ excretion.