Renal Mechanism of Trimethoprim-induced Hyperkalemia

  title={Renal Mechanism of Trimethoprim-induced Hyperkalemia},
  author={Heino Vel{\'a}zquez and Mark A Perazella and Fred Wright and David H. Ellison},
  journal={Annals of Internal Medicine},
Table. SI Units Hyperkalemia is increasingly being recognized in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) [1-7]. In this setting, it is likely that hyperkalemia is the result of inadequate renal potassium excretion. Three mechanisms could be responsible for renal potassium retention: adrenal insufficiency with inadequate production of aldosterone; acute renal failure with reduced glomerular filtration and damage to tubule cells… 
Trimethoprim-induced hyperkalemia in renal transplant recipient
A case of hyperkalemia associated with TMP-SMX occurring in a 32-year-old renal transplant recipient with no other risk factors for hyperKalemia is reported, which reverted to normal with withdrawal of trimethoprim.
Hyperkalemia and High-Dose Trimethoprim/Sulfamethoxazole
It is crucial for clinicians to monitor closely the serum potassium concentration in this patient population, especially during therapy with high doses of TMP, because of the structural similarity of these agents.
Trimethoprim-Induced Hyperkalaemia
In circumstances where continued treatment with trimethoprim is required, induction of high urinary flow rates with intravenous fluids and a loop diuretic, as well as alkalinisation of the urine, have been shown to block the antikaliuretic effect of trimethOPrim on distal nephron cells.
Severe hyperkalemia in two renal transplant recipients treated with standard dose of trimethoprim-sulfamethoxazole.
Hyperkalemia is a serious electrolyte disorder and is a frequent finding in renal transplant recipients. Trimethoprim-induced hyperkalemia has been increasingly reported in recent years. We describe
Case report: reversible hyperkalemia associated with trimethoprim- sulfamethoxazole.
  • M. Marinella
  • Medicine
    The American journal of the medical sciences
  • 1995
A case of hyperkalemia associated with TMP-SMK occurring in an elderly man with no other risk factors for hyperKalemia, which resolved upon discontinuation of the drug is reported.
Reversal of Trimethoprim-Induced Antikaliuresis in an HIV Patient With Pneumocystis Pneumonia
A case of a patient with severe PJP causing respiratory failure treated with high-dose trimethoprim-sulfamethaxazole who experienced hyperkalemia was successfully managed with a combination of fludrocortisone and furosemide allowing completion of antibiotic course.
Trimethoprim-associated hyponatremia.
A 28-year-old man with HIV and Pneumocystis pneumonia who developed hyponatremia while receiving trimethoprim-sulfamethoxazole (TMP/SMX) is reported, and a stepwise approach to the diagnosis is illustrated.
Hyperkalemia in Hospitalized Patients Treated with Trimethoprim-Sulfamethoxazole
Evaluating the effect of standard-dose trimethoprim-sulfamethoxazole on the development of hyperkalemia in hospitalized patients treated for various infectious processes found no change in potassium homeostasis or renal function.
Severe Symptomatic Hyponatremia Induced by Trimethoprim-Sulfamethoxazole
This paper is the first to emphasize this complication and the need of greater awareness among elderly population and suggest the sodium serum levels should be monitored closely during therapy with TMP-SMX.
Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients
Patiromer and sodium zirconium cyclosilicate may play an important role in the management of chronic hyperkalemia in kidney transplant patients, although additional long-term studies are necessary to confirm these effects.


Nephrotoxicity and hyperkalemia in patients with acquired immunodeficiency syndrome treated with pentamidine.
Hyporeninemic hypoaldosteronism associated with acquired immune deficiency syndrome.
New clinical approach to evaluate disorders of potassium excretion.
A new clinical approach to patients with disorders of potassium excretion using a urinary index, the ratio of potassium concentrations in the urine to vein after adjusting the urine potassium concentration for medullary water abstraction, provides a semiquantitative assessment of the apparent transtubular potassium concentration gradient in the major distal nephron segment where potassium is secreted.
Evidence of endocrine involvement early in the course of human immunodeficiency virus infection.
Findings obtained in HIV-seropositive subjects without infections or tumors and who were not receiving medical therapy suggest an effect of HIV on each of the endocrine systems examined.
Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone.
In patients with AIDS, oral therapy with trimethoprim-sulfamethoxazole and with trimetrim-dapsone are equally effective for mild-to-moderate first episodes of P. carinii pneumonia, but with trimmedethopim- dapsone there are fewer serious adverse reactions than with trimETHoprim.
Endocrinologic and metabolic manifestations of the acquired immunodeficiency syndrome.
The endocrine abnormalities associated with acquired immunodeficiency syndrome (AIDS) are reviewed. These include adrenal insufficiency, hyporeninemic hypoaldosteronism, panhypopituitarism,
Endocrine complications of the acquired immunodeficiency syndrome.
  • D. Aron
  • Medicine
    Archives of internal medicine
  • 1989
Recognition and prompt therapy for endocrine dysfunction is essential for optimal treatment of patients with AIDS, particularly in the setting of chronically and severely ill patients.
The effect of trimethoprim on sodium transport across the frog skin epithelium.
Renal potassium handling during states of low aldosterone bio-activity: a method to differentiate renal and non-renal causes.
The purpose of this study was to examine renal potassium handling in patients with low aldosterone bio-activity, and found that in some, the TTKG rose when a pharmacologic but not a physiologic dose of mineralocorticoid was given; others had little renal response to the administration of this hormone.
Renal aspects of therapy for human immunodeficiency virus and associated opportunistic infections.
The renal, fluid, and electrolyte complications of drugs used to treat human immunodeficiency virus and associated opportunistic infections are summarized.