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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Potassium&#44; the primary intracellular cation&#44; is essential in physiological processes such as cell membrane excitability&#44; as well as solute and ion transport&#46; Maintenance of potassium homeostasis is an essential physiological function&#46; Under normal conditions&#44; 90&#37; of dietary potassium intake is absorbed in the small intestine&#44; and an amount equivalent to that absorbed is excreted in the distal tubules of the kidney&#46; The colon&#39;s contribution to potassium absorption and excretion is insignificant&#46; The amount of potassium that is excreted in the faeces of a healthy person is close to 10<span class="elsevierStyleHsp" style=""></span>mmol per day&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Multiple studies&#44; the oldest of which were published in the 1960s&#44; demonstrate the importance of maintaining potassium homeostasis through the gastrointestinal tract in patients with end stage renal disease&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 74-year-old patient with end stage renal disease failure since 1999 likely secondary to a glomerular disease which was not biopsied with a decrease in kidney mass &#40;right nephrectomy due to type I clear-cell papillary renal carcinoma in 2011&#41;&#44; who started haemodialysis in November 2011&#46; In 2014&#44; the patient was diagnosed with attenuated familial adenomatous polyposis and underwent endoscopic resection of several polyps&#46; Later on&#44; in September 2015&#44; a subtotal colectomy was performed&#44; due to his high risk of developing colorectal cancer&#46; A resection of the ileum up to the sigmoid colon&#8211;rectum and a termino-terminal anastomosis were performed without complications&#46; The patient was discharged a week after surgery&#46; Two weeks after discharge&#44; the patient showed a gradual increase in plasma potassium&#44; with a peak level of 7&#46;1<span class="elsevierStyleHsp" style=""></span>mEq&#47;l in February 2016 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A review of the patient&#39;s prior venous blood gases revealed that he had never had metabolic acidosis&#44; that could potentially explain his hyperkalaemia&#46; Moreover&#44; his dialysis suitability parameters were correct and had not changed in the last 6 months &#40;online haemodiafiltration&#44; with convective volumes of 28&#8211;30<span class="elsevierStyleHsp" style=""></span>l&#47;session&#44; Kt&#47;V of 1&#46;6&#8211;1&#46;8 and Kts of 56&#8211;61&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An interview of the patient about his diet confirmed that he followed a suitable low-potassium diet with an estimated potassium intake of around 30&#8211;40<span class="elsevierStyleHsp" style=""></span>mEq&#47;day&#46; Particular emphasis was placed on an ongoing basis on the importance of maintaining a low-potassium diet&#46; Even so&#44; it was necessary to start treatment with calcium polystyrene sulphonate at a dose of one sachet &#40;15<span class="elsevierStyleHsp" style=""></span>g&#41; per day&#44; initially on alternating days&#44; then every 24<span class="elsevierStyleHsp" style=""></span>h&#46; Despite these measures&#44; the patient&#39;s potassium levels remained high&#46; Consequently&#44; the level of potassium in his dialysis fluid was also lowered &#40;from 2 to 1<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#41;&#46; After this&#44; his potassium levels remained below 6<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A progressive decline in or maintenance of kidney function is associated with an increase in capacity for potassium secretion in the colon&#46; The mechanism through which colon secretion of potassium is increased in these patients is complex and depends on several factors&#46; On one hand&#44; there is an increase in Na&#43;&#47;K&#43;&#8211;ATPase pump activity in the basolateral membrane of the intestinal cell&#46; This leads to an increase in intracellular potassium levels as well as an increase in potassium conductivity in apical cells&#46; Colon secretion of potassium is also increased by aldosterone&#46; Although its mechanism has not yet been fully reported&#44; it appears to be related to an increase in expression of large-conductance potassium channels &#40;BK channels&#41; in the apical membrane of the intestinal cell&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Konowa et al&#46; published a case<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> in 2013 on a patient with end stage renal disease undergoing haemodialysis who underwent surgical resection of the ileocaecal junction and a temporary ileostomy&#46; After this&#44; the patient developed hyperkalaemia&#44; which resolved following reanastomosis of the colon&#46; Various <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span> studies have used immunohistochemistry techniques to show that there is greater BK channel expression in patients with end stage renal disease than in those with normal kidney function&#44; in whom small- or intermediate-conductance potassium channel expression predominates&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; potassium secretion in the gastrointestinal tract is a complex and essential mechanism for maintaining its homeostasis in patients with terminal end stage renal disease&#46; Our case demonstrated the importance of potassium secretion in the colon in patients with end stage renal disease&#46;</p></span>"
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Letter to the Editor
Hyperkalemia of non-renal origin in a haemodialysis patient
Hiperpotasemia de causa no renal en paciente en hemodiálisis
Paola Rodríguez
Corresponding author
pao.rodriguezra@gmail.com

Corresponding author.
, Evangelina Mérida, Eduardo Hernández, Mónica Milla, Manuel Praga
Hospital Universitario 12 de Octubre, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Potassium&#44; the primary intracellular cation&#44; is essential in physiological processes such as cell membrane excitability&#44; as well as solute and ion transport&#46; Maintenance of potassium homeostasis is an essential physiological function&#46; Under normal conditions&#44; 90&#37; of dietary potassium intake is absorbed in the small intestine&#44; and an amount equivalent to that absorbed is excreted in the distal tubules of the kidney&#46; The colon&#39;s contribution to potassium absorption and excretion is insignificant&#46; The amount of potassium that is excreted in the faeces of a healthy person is close to 10<span class="elsevierStyleHsp" style=""></span>mmol per day&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Multiple studies&#44; the oldest of which were published in the 1960s&#44; demonstrate the importance of maintaining potassium homeostasis through the gastrointestinal tract in patients with end stage renal disease&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 74-year-old patient with end stage renal disease failure since 1999 likely secondary to a glomerular disease which was not biopsied with a decrease in kidney mass &#40;right nephrectomy due to type I clear-cell papillary renal carcinoma in 2011&#41;&#44; who started haemodialysis in November 2011&#46; In 2014&#44; the patient was diagnosed with attenuated familial adenomatous polyposis and underwent endoscopic resection of several polyps&#46; Later on&#44; in September 2015&#44; a subtotal colectomy was performed&#44; due to his high risk of developing colorectal cancer&#46; A resection of the ileum up to the sigmoid colon&#8211;rectum and a termino-terminal anastomosis were performed without complications&#46; The patient was discharged a week after surgery&#46; Two weeks after discharge&#44; the patient showed a gradual increase in plasma potassium&#44; with a peak level of 7&#46;1<span class="elsevierStyleHsp" style=""></span>mEq&#47;l in February 2016 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A review of the patient&#39;s prior venous blood gases revealed that he had never had metabolic acidosis&#44; that could potentially explain his hyperkalaemia&#46; Moreover&#44; his dialysis suitability parameters were correct and had not changed in the last 6 months &#40;online haemodiafiltration&#44; with convective volumes of 28&#8211;30<span class="elsevierStyleHsp" style=""></span>l&#47;session&#44; Kt&#47;V of 1&#46;6&#8211;1&#46;8 and Kts of 56&#8211;61&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An interview of the patient about his diet confirmed that he followed a suitable low-potassium diet with an estimated potassium intake of around 30&#8211;40<span class="elsevierStyleHsp" style=""></span>mEq&#47;day&#46; Particular emphasis was placed on an ongoing basis on the importance of maintaining a low-potassium diet&#46; Even so&#44; it was necessary to start treatment with calcium polystyrene sulphonate at a dose of one sachet &#40;15<span class="elsevierStyleHsp" style=""></span>g&#41; per day&#44; initially on alternating days&#44; then every 24<span class="elsevierStyleHsp" style=""></span>h&#46; Despite these measures&#44; the patient&#39;s potassium levels remained high&#46; Consequently&#44; the level of potassium in his dialysis fluid was also lowered &#40;from 2 to 1<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#41;&#46; After this&#44; his potassium levels remained below 6<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A progressive decline in or maintenance of kidney function is associated with an increase in capacity for potassium secretion in the colon&#46; The mechanism through which colon secretion of potassium is increased in these patients is complex and depends on several factors&#46; On one hand&#44; there is an increase in Na&#43;&#47;K&#43;&#8211;ATPase pump activity in the basolateral membrane of the intestinal cell&#46; This leads to an increase in intracellular potassium levels as well as an increase in potassium conductivity in apical cells&#46; Colon secretion of potassium is also increased by aldosterone&#46; Although its mechanism has not yet been fully reported&#44; it appears to be related to an increase in expression of large-conductance potassium channels &#40;BK channels&#41; in the apical membrane of the intestinal cell&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Konowa et al&#46; published a case<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> in 2013 on a patient with end stage renal disease undergoing haemodialysis who underwent surgical resection of the ileocaecal junction and a temporary ileostomy&#46; After this&#44; the patient developed hyperkalaemia&#44; which resolved following reanastomosis of the colon&#46; Various <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span> studies have used immunohistochemistry techniques to show that there is greater BK channel expression in patients with end stage renal disease than in those with normal kidney function&#44; in whom small- or intermediate-conductance potassium channel expression predominates&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; potassium secretion in the gastrointestinal tract is a complex and essential mechanism for maintaining its homeostasis in patients with terminal end stage renal disease&#46; Our case demonstrated the importance of potassium secretion in the colon in patients with end stage renal disease&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rodr&#237;guez P&#44; M&#233;rida E&#44; Hern&#225;ndez E&#44; Milla M&#44; Praga M&#46; Hiperpotasemia de causa no renal en paciente en hemodi&#225;lisis&#46; Nefrologia&#46; 2018&#59;38&#58;96&#8211;97&#46;</p>"
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Idiomas
Nefrología (English Edition)