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Doc: So you understand about your potassium intake? Dialysis Patient: Yeah, if I eat too many bananas my heart stops!. N. a. Cortical Collecting Duct Principal Cell Regulated Potassium Secretion. Tubular Fluid. Na +. K +. K +. Interstitial Fluid. N. a.

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Presentation Transcript

Doc:

So you understand about your potassium intake?

Dialysis Patient:

Yeah, if I eat too many bananas my heart stops!


N

a

Cortical Collecting Duct Principal Cell

Regulated Potassium Secretion

Tubular Fluid

Na+

K+

K+

Interstitial Fluid


N

a

Cortical Collecting Duct Intercalated Cell

Regulated Potassium Reabsorption

K+

ATP

H+

?

K+

Interstitial Fluid


Factors which Influence K Secretion

  • Dietary Potassium and Plasma Potassium

  • Aldosterone

  • Flow Rate of the Tubular Fluid

  • ADH

  • Acid-Base Balance


Na+

K+

CCD Principal Cell

K+

K+

N

a

1

2

Potassium Secretion: Effects of Plasma K+ and Dietary K+

High K+ diet

Potassium Secretion (mEq/day)

Normal diet

3 4 5 6 7 8

PK(mEq/L)


K+

Adenal Cortex

Aldosterone

+

FEK


-Vte

Na+

Na+

Late Phase

AR

N

N

a

a

Early

Aldosterone Increases Potassium Secretion

Tubular Fluid

K+

R

A

K+

Interstitial Fluid


K+

Na+

Physiological Range

K+

CCD Principal Cell

K+

K+

N

a

Potassium Secretion: Effects of Tubular Fluid Flow Rate

High K+ diet

Normal diet

Potassium Secretion (mEq/day)

Low K+ diet

0 10 20 30 40 50

Distal Flow Rate(nl/min)


Na+

ADH

N

a

ADH Increases Apical Potassium Channels

Tubular Fluid

K+

Principal Cell

K+

V2

Interstitial Fluid


Na+

K+

CCD Principal Cell

K+

K+

N

a

1

2

Potassium Secretion: Acute pH Effects

Alkalosis, pH 7.5

Normal, pH 7.4

Potassium Secretion (mEq/day)

Acidosis, pH 7.2

3 4 5 6 7 8

PK(mEq/L)


Loop

Diuretics

ECV

Distal

K delivery

Distal Flow

Aldo

Distal K

Secretion

K

Excretion


N

a

25y/o Male with Liddle Syndrome, a Familial

“Salt-Sensitive” Hypertension

At Dx: BP 170/110 , PNa 140 mEq/l, PK 2.5 mEq/l ,

Low Renin/Aldosterone

Vte-

Na+

Tubular Fluid

R

K+


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