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July 1977

Nonuremic Diabetic Hyperkalemia: Possible Role of Insulin Deficiency

Author Affiliations

New Haven, Conn

Arch Intern Med. 1977;137(7):842-843. doi:10.1001/archinte.1977.03630190010005

Hyperkalemia is seen infrequently in chronic renal failure unless the glomerular filtration rate is severely reduced (<20 ml/min) or acidosis supervenes.1,2 However, since the initial description in 1957 by Relman et al,1 an increasing number of reports documenting the presence of hyperkalemia in subjects with normal or only moderately impaired renal function have appeared. In the majority of these cases, a defect in renin synthesis and/or release (Figure, step 1) has been postulated. Of the 50 reported cases,2* the majority have had mild to moderate renal failure (74%) and/or diabetes mellitus (46%). Plasma concentration or urinary excretion of aldosterone or both have been found to be depressed in all subjects and in none has there been a normal rise in concentration after volume contraction. In 80% to 85% of the cases, basal plasma renin activity has been shown to be depressed and a subnormal or absent rise

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