Kaliopenic nephropathy revisited

Abstract

In the 'older' literature, a definitive renal pathology was described in patients with long-standing hypokalaemia and depletion of the body's potassium reserves. The topic is relevant because possibly a quite cheaply reversible element in the course of chronic kidney disease progression could be addressed. Earlier, pathologists drew attention to vacuolar changes in renal tubular epithelium accompanied by inflammatory interstitial changes in patients with potassium losses. The diagnostic term 'kaliopenic nephropathy' was coined to describe such patients. Kaliopenic nephropathy now receives less emphasis than in earlier times. However, with eating disorders, laxative abuse and other potential causes, we suggest that the syndrome should be resurrected.

Keywords: bisacodyl; hypokalaemia; laxatives; melanosis coli; potassium.

Fig. 1.

Normal-appearing colonic epithelium is seen with lipofuscin-laden macrophages residing under the mucous layer.

Fig. 2.

(A) Normal glomerulus, several proximal tubules with widespread vacuolization and some hyaline casts. (B) Dense lymphocytic interstitial infiltrate, hyaline casts and dilated distal tubules with cellular detritus. (C) Dilated proximal tubules with vacuolization. (D) Normal proximal tubules next to proximal tubules with pronounced vacuolization.