Disposition and regulation of body potassium: an overview

Most of filtered K+ is reabsorbed passively in the proximal tubule since the tubular fluid (TF): plasma (P) concentration ratio is almost identical to the equilibrium value calculated from the transtubular potential difference. In the loop of Henle, K+ also moves passively along chemical and electrical gradients. Only 5-10% of the filtered K+ remains in the early distal convoluted tubule. In the distal convoluted tubule TF/P K+ is lower than the calculated equilibrium value suggesting that K+ is passively secreted and actively reabsorbed. Most of the excreted K+ had been secreted by the end of the distal convoluted tubule. Aldosterone increases K+ secretion in this segment, an effect that may be dissociated from the effect on Na+. The relation between K+ secretion and Na+ absorption is the consequence of the luminal electronegativity produced by Na+ absorption and is not stoichiometric. Acidosis and alkalosis decrease and increase K+ secretion in the distal tubule respectively; this is not due to reciprocal changes in H+ secretion. Normally, some K+ is reabsorbed in the collecting duct. During K+ deprivation and loading the collecting duct may participate in the conservation or elimination of K+ respectively. Adaptation to chronic K+-loading consists of renal and extrarenal factors. The extrarenal mechanism is aldosterone-dependent and consists of rapid uptake of K+ by muscle. The renal mechanism consists of increased K+ secretion by the distal tubule. Luminal electronegativity and increased K+ pool in the distal tubular cell play a crucial role.