Etiology
Hypoaldosteronism (see Hypoaldosteronism)
Decreased Aldosterone Synthesis
- Inherited Disorders
- 21 Hydroxylase Deficiency
- Pseudohypoaldosteronism Type 2 (Gordon’s Syndrome)
- Hyporeninemic Hypoaldosteronism
- Advanced Age
- Drug-Induced Hyporeninemic Hypoaldosteronism
- Beta Blockers (see β-Adrenergic Receptor Antagonists)
- Calcineurin Inhibitors (see Calcineurin Inhibitors)
- Nonsteroidal Anti-Inflammatory Drug (NSAID) (see Nonsteroidal Anti-Inflammatory Drug)
- Intrinsic Renal Disease
- Acute Glomerulonephritis with Volume Expansion (see Acute Glomerulonephritis)
- Chronic Kidney Disease (CKD) (see Chronic Kidney Disease): with chronic interstitial nephritis
- Diabetic Nephropathy (see Diabetes Mellitus)
- Drugs
- Angiotensin Converting Enzyme (ACE) Inhibitors
- Captopril (Capoten) (see Captopril)
- Enalapril (Vasotec, Enalaprilat) (see Enalapril)
- Fosinopril (Monopril) (see Fosinopril)
- Lisinopril (Zestril) (see Lisinopril)
- Moexipril (Univasc) (see Moexipril)
- Perindopril (Coversyl, Coversum, Preterax, Aceon) (see Perindopril)
- Quinapril (Accupril) (see Quinapril)
- Ramipril (Altace) (see Ramipril)
- Trandolapril (Mavik) (see Trandolapril)
- Angiogensin II Receptor Blockers (ARB’s)
- Candesartan (Atacand) (see Candesartan)
- Fimasartan (Kanarb) (see Fimasartan)
- Irbesartan (Avapro, Aprovel, Karvea) (see Irbesartan)
- Losartan (Cozaar) (see Losartan)
- Olmesartan (Benicar, Olmecip) (see Olmesartan)
- Telmisartan (Micardis) (see Telmisartan)
- Valsartan (Diovan) (see Valsartan)
- Heparins
- Enoxaparin (Lovenox) (see Enoxaparin)
- Heparin (see Heparin)
- Renin Inhibitors
- Aliskiren (Tekturna, Rasilez) (see Aliskiren): renin inhibitor (may cause hyperkalemia when used in combination with ACE inhibitors or ARB’s)
- Angiotensin Converting Enzyme (ACE) Inhibitors
- Other
- Severe illness
- Primary Adrenal Insufficiency (see Adrenal Insufficiency)
Aldosterone Resistance
- Inherited Disorders
- Pseudohypoaldosteronism Type 1
- Drugs
- Aldosterone Antagonists
- Drospirenone (Yasmin, Yasminelle, Yaz, Beyaz, Ocella, Zarah, Angeliq) (see Drospirenone)
- Eplerenone (Inspra) (see Eplerenone)
- Spironolactone (Aldactone) (see Spironolactone)
- Epithelial Sodium Channel (ENaC) Antagonists
- Amiloride (see Amiloride)
- Cimetidine (Tagamet) (see Cimetidine)
- Nafamostat: synthetic serine protease inhibitor, used as an anticoagulant
- Pentamidine (see Pentamidine)
- Triamterene (see Triamterene)
- Trimethoprim (see Sulfamethoxazole-Trimethoprim)
- Aldosterone Antagonists
- Other
- Tubulointerstitial Renal Disease
- Amyloidosis (see Amyloidosis)
- Obstructive Uropathy
- Post-Acute Tubular Necrosis (ATN) (see Acute Kidney Injury)
- Sickle Cell Disease (see Sickle Cell Disease
- Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)
- Tubulointerstitial Renal Disease
Physiology
Aldosterone Deficiency/Resistance -> Impaired Distal Tubular Ammonium Generation
- Results in impaired hydrogen ion excretion (impaired renal acid excretion)
- Renal Bicarbonate Loss Results in Bicarbonate Being Replaced by Chloride, Resulting in Hyperchloremia
Diagnosis
- Serum Potassium (see Serum Potassium): normokalemia/hyperkalemia
- Urine pH: <5.4
- Urine Anion Gap: (urine Na+ + urine K+) – (urine Cl-)
- Normal: -20 to -50 mEq/L
- Positive: due to decreased renal ammonium ion (NH4+) excretion, as NH4Cl
Clinical Manifestations
Renal Manifestations
Hyperkalemia (see Hyperkalemia)
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Non-Anion Gap Metabolic Acidosis (NAGMA) (see Metabolic Acidosis-Non Anion Gap)
Absence of Sodium-Wasting and Hyponatremia
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Treatment
- Bumetanide (Bumex) (see Bumetanide
- Sodium Bicarbonate (see Sodium Bicarbonate): may be added to bumex therapy
- Alternate Therapy: Fludrocortisone (Florinef) (see Fludrocortisone)
- Dose: 0.2-0.5 mg/day
References
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