Potassium and kidney stones

Q: 42 years old male is admitted to ICU with sepsis due to severe pyelonephritis. The patient has a chronic history of kidney stones. Patient potassium appears to be lower. Aggressive potassium repletion is ordered. Hyperkalemia increases the risk of nephrolithiasis?

A) True

B) False

Answer: B

Hyperkalemia (or a potassium level on the higher side of normal) decreases the risk of kidney stones. High potassium, particularly from an oral route, reduces urinary calcium excretion. It also increases urinary citrate excretion, thereby increasing urine's inhibitory properties. 

#electrolytes

#nephrology

References:

1. Domrongkitchaiporn S, Stitchantrakul W, Kochakarn W. Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion. Am J Kidney Dis 2006; 48:546.

2. Ferraro PM, Mandel EI, Curhan GC, et al. Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. Clin J Am Soc Nephrol 2016; 11:1834.

3. Lemann J Jr, Pleuss JA, Gray RW, Hoffmann RG. Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults [corrected]. Kidney Int 1991; 39:973.