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Colegio de Medicina Interna de México.

2021, Number 2

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Med Int Mex 2021; 37 (2)

Potassium homeostasis: pathophysiological basis of hereditary tubulopathies

Flores-Delgado A, Hernández-García LR, Beltrán-Reyes P, Silerio-Maqueo G, Ahumada-Ayala M

Language: Spanish
References: 34
Page: 230-243
PDF size: 585.59 Kb.


ABSTRACT

Potassium is the main intracellular cation, its asymmetric distribution between intra and extracellular space relies mainly on the activity of the Na+/K+ ATPase pump. Any variation in potassium levels may alter the functionality of excitable tissues, underlining the importance of these precise regulatory processes. In this article we review the mechanisms responsible for the regulation of potassium balance with particular emphasis on the renal regulation of potassium excretion. This is followed by a brief discussion of the classification, pathophysiology and diagnostic approach of the most common tubulopathies. The internal balance of potassium refers to the regulation of the intra/extracellular distribution of this cation, avoiding short term fluctuations in potassium concentration induced by variations in dietary potassium content. Internal balance is regulated by insulin and catecholamines acting through specific intracellular signaling mechanisms. The external balance of potassium are the predominantly renal mechanisms that adjust potassium excretion to match the potassium dietary intake. The excretion of potassium by the kidney results from the balance between potassium reabsorption in the proximal nephron and the complex potassium secretory mechanisms of the distal nephron. Among the principal regulating factors of potassium secretion in the distal nephron are the delivery of sodium and water and aldosterone. Mineralocorticoid activity is regulated intracellularly by WNK proteins. The electrolyte and acid-base profile as well as the presence of hypo or hyperkalemia are the cornerstones for the diagnostic approach of hereditary or acquired tubulopathies. Knowledge of the homeostatic mechanisms that regulate potassium balance are a guide for the clinician to the correct diagnosis and therapy of the most common disorders of potassium excretion.


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