What are the most common causes of decreased excretion of potassium in hyperkalemia (high serum potassium level)?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Decreased excretion of potassium, especially when coupled with excessive intake, is the most common cause of hyperkalemia. The most common causes of decreased renal potassium excretion include the following:

  • Renal failure (most common) [15]

  • Medications that interfere with potassium excretion (eg, potassium-sparing diuretics, angiotensin-converting enzyme [ACE] inhibitors, [16, 17, 18, 19] and nonsteroidal anti-inflammatory drugs [NSAIDs])

  • Reduced aldosterone production

  • Impaired responsiveness of the distal tubule to the action of aldosterone (eg, type IV renal tubular acidosis observed with diabetes mellitus, sickle cell disease, or chronic partial urinary tract obstruction) [20, 21]

  • Primary adrenal disease (eg, Addison disease or salt-wasting forms of congenital adrenal hyperplasia)

  • Hyporeninemic hypoaldosteronism or renal tubular disease (pseudohypoaldosteronism I [22] or II)

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