Laboratory Investigation

Kidney International (1986) 30, 532–537; doi:10.1038/ki.1986.218

Paradoxical potassium depletion: A renal mechanism for extrarenal potassium adaptation

Aaron Spital1 and Richard H Sterns1

1Rochester General Hospital, University of Rochester School of Medicine, Rochester, New York U.S.A.

Correspondence: Aaron Spital MD, Rochester General Hospital, 1425 Portland Avenue, Rochester, New York 14621, USA.

Received 11 June 1985; Revised 22 October 1985; Re-revised 28 January 1986.

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Abstract

Paradoxical potassium depletion: a renal mechanism for extrarenal potassium adaptation. Following nephrectomy and acute potassium loading, animals previously maintained on a high potassium diet have a smaller increment in plasma potassium than do animals on a control diet. The mechanism of this "extrarenal potassium adaptation" is not known. To explore the role of potassium depletion in this process, we studied rats adapted to either a high potassium (HK) or control (C) diet. When dietary potassium was withdrawn, urinary potassium losses in HK rats greatly exceeded those in C rats for at least two days, leading to greater potassium depletion in HK than C animals. A smaller increment in plasma potassium in HK compared to C rats was seen only after prolonged fasting preceded nephrectomy and acute potassium loading. Correction of potassium depletion incurred during fasting abolished extrarenal potassium adaptation. We conclude: 1) after withdrawal of dietary potassium, urinary potassium losses are much greater in HK than in C rats; 2) if the duration of dietary potassium deprivation is sufficient, these urinary potassium losses will cause potassium–adapted animals to paradoxically become more potassium depleted than controls; and 3) this paradoxical potassium depletion may be responsible for extrarenal potassium adaptation.

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