Table 4.

Causes of hyperkalemic RTA (type 4)

I. Primary hyperkalemic RTA
     1. early childhood hyperkalemia (transient)
II. Secondary hyperkalemic RTA
     1. mineralocorticoid deficiency
      a. in absence of renal disease (Addison’s disease, isolated hypoaldosteronism, congenital adrenal hyperplasia)
      b. hyporeninemic hypoaldosteronism in patients with chronic nephropathies (diabetic nephropathy, systemic lupus erythematosus, AIDS nephropathy)
      c. hyporeninemic hypoaldosteronism in patients with acute glomerulonephritis
     2. mineralocorticoid resistance
      a. in genetic diseases (primary pseudohypoaldosteronism type 1, primary pseudohypoaldosteronism type 2, or Gordon syndrome)
      b. in chronic interstitial nephropathies (obstructive uropathy, medullary cystic disease, drug-induced interstitial nephritis, renal transplant rejection, analgesic abuse nephropathy, AIDS nephropathy)
     3. drug-induced hyperkalemia
      a. impaired renin-aldosterone elaboration (cyclo-oxygenase inhibitors, converting enzyme inhibitors, heparin)
      b. inhibitors of renal K+ secretion (potassium-retaining diuretics, trimethoprim, pentamidine, cyclosporin A)
      c. altered K+ distribution (insulin antagonists, β-adrenergic antagonists, α-adrenergic agonists, digitalis, succinylcholine)