Regulation of Potassium Excretion in the Kidney

The maintenance of potassium balance depends primarily on excretion by the kidney. The regulated secretion of potassium normally accounts for most of urinary potassium excretion. Potassium transport along the nephron has two main features:the ubiquitous Na,K-ATPase defines basolateral membranes, whereas site-specific potassium transporters are responsible for the apical transport. Two different cell types mediate secretion and reabsorption of potassium. Principal cells secrete potassium, whereas intercalated cells, especially those belonging to the subfamily of beta-intercalated cells, reabsorb potassium. The factors that stimulate potassium secretion by the principal cells include (1) increased extracellular fluid potassium concentration (2) increased aldosterone and (3) increased tubular flow rate. One factor that decreases potassium secretion is increased hydrogen concentration (acidosis). In situations associated with severe potassium depletion, there is a cessation of potassium secretion and net reabsorption of potassium. It is believed that H,K-ATPase transport mechanism located in the luminal membrane of the cortical and outer medullary collecting duct cells reabsorb potassium in exchange for hydrogen secreted into the tubular lumen.

Physiology and Pathophysiology of Transcellular Shift of Potassium Balance

Plasma potassium level is maintained within a narrow normal range through a transcellular shift between intracellular and extracellular space, and through renal excretion. Internal potassium balance via transcellular shift is affected by several hormones and physiologic conditions. Catecholamine through beta2-adrenergic receptor stimulates cellular uptake of potassium and defends against increments in plasma potassium concentration. Insulin promotes cellular potassium uptake in muscle, liver and adipose tissues. Changes of acid-base status affects internal potassium balance as well as renal potassium excretion. Other physiologic and pathophysiologic conditions such as exercise or tissue damage also have acute effects on the distribution of potassium. Although a lot of medications are the causes of hyperkalemia, drugs that alter internal potassium balance would appear to be uncommon. Understanding the physiology of potassium distribution is important to evaluate and manage the patients with potassium disturbances including hypokalemia or hyperkalemia.

A Study on Sodium and Potassium Balance of College Women in Seoul / 대한지역사회영양학회지

The purpose of this study was to investigate Na and K balances in healthy adult women. Anthropometric assessments, biochemical analysis of blood, 3-day dietary flood records and collections of 3-day food, 24-hr urine and faces were performed to evaluate intakes and excretions of Na and K in 20 college women living in Seoul. The mean BMI and blood pressure of the subjects were 21.08 and 110.25/67.50mmHg, respectively. Mean daily intake of energy was 1578.84 kcal, 79% of Korean RDA. Also, daily intakes of Na and K ware 120.86mEq and 44.20mEq. The urinary and fecal excretions of Na were 99.88 and 4.45mEq/day, and those of K were 30.41 and 8.66mEq/day, respectively. The body retention, retention rate, and apparent absorption of Na were 17.11mEq, 13.23%, and 96.31%, and those of K were 5.82mEq, 8.69%, and 80.12%, respectively. The urinary and fecal Na/K ratio were 3.48 and 0.52. There were significantly positive correlations between 1) urinary Na, K excretions and intakes of Na or K, 2) urinary K and BMI, 3) serum K and serum globulin, and 4) urinary Na excretion and serum haptoglobin level, respectively. The results of this study show that Na intake was higher and K intake was lower than those of other advanced nations. Therefore, nutrition education show instruct people to reduce Na intake and to increase K intake.