What is included in the treatment of hyperkalemic distal renal tubular acidosis (dRTA)?

Updated: Oct 18, 2018
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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With hyperkalemic dRTA, entities amenable to intervention, such as obstructive uropathy, must be identified.

In general, distal sodium delivery is increased if patients increase their ingestion of dietary salt, taking into account that many of these patients have concomitant cardiorenal compromise.

Fluid overload can be overcome with the addition of furosemide to a high-salt diet. This combination encourages distal delivery of sodium by rendering the collecting tubule impermeable to chloride, and it increases the exchange of sodium for hydrogen and potassium.

Mineralocorticoid therapy (ie, fludrocortisone in daily doses of 0.1-0.2 mg) is sometimes useful for aldosterone deficiency, but care needs to be taken when combining mineralocorticoid therapy with diuretics (in order to prevent precipitation of heart failure).

Foods with a high potassium content and drugs that may aggravate hyperkalemia (eg, ACE inhibitors, potassium-sparing diuretics, beta blockers) must be avoided.

Cation-exchange resins (eg, sodium polystyrene sulfonate [Kayexalate], alkalinizing salts) can be helpful in controlling hyperkalemia.

In many instances, careful evaluation of iatrogenic offenders (eg, beta blockers, ACE inhibitors) can explain persistently high potassium levels in the absence of moderate to severe renal failure.

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