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Published ahead of print on January 23, 2008
J Am Soc Nephrol 19: 424-426, 2008
© 2008 American Society of Nephrology
doi: 10.1681/ASN.2007091017
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Clinical Commentary

The Utility of the Transtubular Potassium Gradient in the Evaluation of Hyperkalemia

Michael J. Choi* and Fuad N. Ziyadeh{dagger}

* Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and {dagger} Departments of Internal Medicine and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

Correspondence: Dr. Fuad N. Ziyadeh, Chairman, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Bliss Street, Beirut, Lebanon. Phone: +961-1-350000, ext 4700; Fax: +961-1-744464; E-mail: fz05{at}aub.edu.lb

The transtubular potassium gradient (TTKG) is used to gauge renal potassium secretion by the cortical collecting duct, indirectly assessing mineralocorticoid bioactivity in patients who have hypo- or hyperkalemia. TTKG values <6 indicate an inappropriate renal response to hyperkalemia, whereas values >2 during hypokalemia point to renal loss. Hypokalemia is not addressed here. Studies supporting the usefulness of the TTKG in hyperkalemia are limited to case series. This calculation may be most useful in distinguishing hyperkalemic patients who have mineralocorticoid deficiency versus resistance by observing a change in TTKG values after physiologic or pharmacologic doses of mineralocorticoids.






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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673