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Hyporeninemic Hypoaldosteronism Medication

  • Author: James H Sondheimer, MD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
Updated: Jul 05, 2016

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications employed in the management of renal tubular acidosis (RTA) type IV include loop and thiazide diuretics, mineralocorticoids, ion-exchange resins, and alkalinizing agents.


Loop diuretics

Class Summary

Diuretics increase sodium and potassium loss in the urine. The latter usually is considered an adverse effect but is the desired effect in treating patients with RTA type IV.

Furosemide (Lasix)


Furosemide inhibits reabsorption of chloride, predominantly in the thick ascending limb of the loop of Henle. The high efficacy of this drug is largely due to the large amount of sodium usually reabsorbed in this site.



Class Summary

These agents provide pharmacologic amounts of mineralocorticoid activity, so that the patient can overcome tubular resistance to physiologic amounts of aldosterone.



Fludrocortisone is used as a third-line agent in patients for whom treatment with diuretics, sodium bicarbonate, and dietary measures has failed. It promotes increased reabsorption of sodium and loss of potassium from renal distal tubules.


Antidotes, Other

Class Summary

By increasing gut excretion of potassium, these agents bypass renal impairment of potassium excretion. Difficult to take on a regular basis, limiting its use in long-term therapy.

Sodium polystyrene sulfonate (Kayexalate, Kalexate, Kionex, SPS)


Sodium polystyrene sulfonate exchanges sodium for potassium and binds in the gut, primarily in the large intestine; it also decreases total body potassium. The time to onset of action ranges from 2-12 hours after oral administration and is longer after rectal administration.


Alkalinizing Agents

Class Summary

Alkalinizing agents provide bicarbonate anion for repletion of patients with metabolic acidosis. They alkalinize the urine, enhancing kaliuresis.

Sodium bicarbonate (Neut)


Sodium bicarbonate is administered intravenously (IV) for emergency treatment of hyperkalemia. It is given orally to patients with metabolic acidosis and hyperkalemia.


Diuretics, Thiazide

Class Summary

Thiazide diuretics are useful in the treatment of RTA type IV by virtue of their kaliuretic effects. They are less likely to produce marked volume depletion than loop diuretics are, and they may be better antihypertensive agents.

Hydrochlorothiazide (Microzide)


Hydrochlorothiazide inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium, water, potassium, and hydrogen ions.

Chlorothiazide (Diuril)


Chlorothiazide inhibits the reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as of potassium and hydrogen ions.

Contributor Information and Disclosures

James H Sondheimer, MD, FACP, FASN Associate Professor of Medicine, Wayne State University School of Medicine; Medical Director of Hemodialysis, Harper University Hospital at Detroit Medical Center; Medical Director, DaVita Greenview Dialysis (Southfield)

James H Sondheimer, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology

Disclosure: Receive dialysis unit medical director fee (as independ ent contractor) for: DaVita .

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.


The author would like to thank Dr Jaideep Hingorani for his many helpful comments and suggestions.

Additional Contributors

Donald A Feinfeld, MD, FACP, FASN Consulting Staff, Division of Nephrology & Hypertension, Beth Israel Medical Center

Donald A Feinfeld, MD, FACP, FASN is a member of the following medical societies: American Academy of Clinical Toxicology, American Society of Hypertension, American Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christie P Thomas, MBBS, FRCP, FASN, FAHA Professor, Department of Internal Medicine, Division of Nephrology, Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics

Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Royal College of Physicians

Disclosure: Nothing to disclose.

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Renin-antiotensin-aldosterone system.
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