Kunis C L, Charney A N
Compr Ther. 1981 Mar;7(3):29-33.
Hyperkalemia caused by decreased renal K+ secretion may be seen in patients with mild, moderate, or severe ARF or CRF. Decreased K+ secretion by the distal tubule may be due primarily to a decrease in tubular fluid flow rate, as in ARF, or it may be due to diminished circulating aldosterone concentrations, as in patients with hyporeninemic hypoaldosteronism. Patients with CRF adapt to K+ loads by increasing K+ excretion per nephron as well as by transferring K+ more rapidly into cells. However, an increased K+ load may still produce hyperkalemia in the CRF patient because of limitations in the adaptive responses. Hyperkalemia may present a true medical emergency in the patient with renal failure. Although the serum K+concentration can usually be controlled by the administration of calcium, glucose and insulin, sodium bicarbonate, diuretics, and/or the use of K+ exchange resins, dialysis may be necessary. Hyperkalemia complicating acute or chronic renal failure is an important, common problem requiring the use of peritoneal dialysis or hemodialysis.
肾钾分泌减少所致的高钾血症可见于轻度、中度或重度急性肾衰竭（ARF）或慢性肾衰竭（CRF）患者。远端肾小管钾分泌减少主要可能是由于肾小管液流速降低，如在急性肾衰竭时，或者可能是由于循环中醛固酮浓度降低，如在低肾素性低醛固酮血症患者中。慢性肾衰竭患者通过增加每个肾单位的钾排泄以及更快地将钾转运到细胞内来适应钾负荷。然而，由于适应性反应存在局限性，增加的钾负荷仍可能在慢性肾衰竭患者中导致高钾血症。高钾血症在肾衰竭患者中可能是真正的医疗急症。尽管血清钾浓度通常可通过给予钙剂、葡萄糖和胰岛素、碳酸氢钠、利尿剂和/或使用钾交换树脂来控制，但可能仍需要进行透析。并发急性或慢性肾衰竭的高钾血症是一个需要使用腹膜透析或血液透析的重要常见问题。
