Hyperkalemic distal renal tubular acidosis associated with obstructive uropathy

N Engl J Med. 1981 Feb 12;304(7):373-80. doi: 10.1056/NEJM198102123040701.


We studied renal function in 13 patients with obstructive uropathy and hyperkalemic metabolic acidosis to characterize the pathogenesis of this disorder. Base-line fractional potassium excretion was lower in all patients than in controls with similar glomerular filtration rates. Acetazolamide was given to 11 patients but failed to increase fractional potassium excretion to normal. In five patients, impaired potassium excretion was associated with decreased ammonium excretion, a urinary pH below 5.5 (5.18 +/- 0.07, mean +/- S.E.M.), and aldosterone deficiency. In the remaining eight patients, the urinary pH did not fall below 5.5 (6.4 +/- 0.2) with acidosis, and we failed to lower the urinary pH and increase fractional potassium excretion to normal by administering a mineralocorticoid and sodium sulfate. A syndrome of hyperkalemic distal renal tubular acidosis may occur in patients with obstructive uropathy. In some patients, this syndrome results from a defect in hydrogen and potassium secretion in the distal nephron rather than from aldosterone deficiency. Obstructive uropathy should be included in the differential diagnosis of hyperkalemic acidosis and renal insufficiency.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acetazolamide / therapeutic use
  • Acidosis, Renal Tubular / diagnosis
  • Acidosis, Renal Tubular / etiology*
  • Acidosis, Renal Tubular / physiopathology
  • Aged
  • Aldosterone / blood
  • Diagnosis, Differential
  • Glomerular Filtration Rate
  • Humans
  • Hyperkalemia / drug therapy
  • Hyperkalemia / etiology*
  • Kidney / physiopathology
  • Kidney Tubules, Distal / physiopathology
  • Middle Aged
  • Mineralocorticoids / therapeutic use
  • Potassium / urine
  • Syndrome
  • Urologic Diseases / complications*


  • Mineralocorticoids
  • Aldosterone
  • Acetazolamide
  • Potassium