Correction of renal failure Hyperkalemia with Furosemide! - USMLE Forums
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Old 12-15-2011
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Kidney Correction of renal failure Hyperkalemia with Furosemide!

A patient in mild renal failure develops a persistently mildly elevated serum K+ level; cortisol levels are normal. The hyperkalemia corrects when furosemide is given. This patient's hyperkalemia is most likely related to which of the following?

A. High renin and high aldosterone
B. High renin and low aldosterone
C. Low renin and high aldosterone
D. Low renin and low aldosterone
E. Normal renin and normal aldosterone
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  #2  
Old 12-15-2011
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Default ????

low renin and low aldosterone??
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Old 12-15-2011
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Default I think...

That the aswer is B...
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Old 12-15-2011
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Quote:
Originally Posted by Dr. Mexito View Post
That the aswer is B...
Can u explain plz?????????
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Old 12-15-2011
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low renin low aldosterone...
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Old 12-16-2011
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Correct Answer In my humble opinion...

Quote:
Originally Posted by daulath singh View Post
Can u explain plz?????????
I was going to say something about low aldosterone levels and high renin levels related to adrenal insufficiency, but then I realized that the patient has normal levels of cortisol (my apologize, missed that one ), so that explanation would be out of context.

I correct my answer and say D, but... Why? Why? The "why" is what drove us here to discuss, right? Well here is my thesis:

A patient with mild renal failure tend to have some problems dealing with the potassium in his body (We all know that). Per se, this mild renal failure can lead him to hyperkalemia, like the one that he just had. But where does renin and aldosterone fit in here??? Well, I am guessing, I am just guessing (Since it was not written in the question) that the patient has DM. This correlates well with the renal failure that DM patients tend to develop and the hyperkalemias that are secondary to the renal failure. In the case of a patient with DM, renal tubular acidosis develops; to be more specific: a type IV renal tubular acidosis, condition that is related to hyperkalemia and yes... low renin and aldosterone levels.

Now, lets wait for the answer

P.S.
I just want to take it out of my chest. Why did I said B??? Well, in the context of unknown cortisol levels, a patient with Addison's disease sounded pretty good to me. Such patients have low aldosterone, high renin and normal cortisol levels. The mid renal failure would be the reason of the hyperkalemia.

Last edited by Dr. Mexito; 12-16-2011 at 08:22 AM.
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Old 12-16-2011
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The answer is D
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Old 12-16-2011
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1. Any renal failure would try to increase GFR by constricting efferent vessel(Angiotensin II ) and dilating afferent vessel(Prostaglandins).
2. Theoretically, activation of RAS axis should correct the renal failure.
3. But in renal failure pt., less renin is secreted and finally less aldosterone, retaining K+.
Answer: D

Last edited by trendsetter; 12-16-2011 at 06:47 PM. Reason: addition
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Endocrine-, Pharmacology-, Physiology-, Renal-, Step-1-Questions

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