- Diuretics that increase flow rate through the distal tubule (e.g., thiazide diuretics, loop diuretics) cause dilution of the luminal K+ concentration, increasing the driving force for K+ secretion. As a result of increased K+ secretion, these diuretics cause hypokalemia.
(e) K+-sparing diuretics
- include spironolactone, triamterene, and amiloride. Spironolactone is an antagonist of aldosterone; triamterene and amiloride act directly on the principal cells.
- decrease K+ secretion. If used alone, they cause hyperkalemia.
- The most important use of the K+-sparing diuretics is in combination with thiazide or loop diuretics to offset urinary K+ losses.
(f) Luminal anions
- Excess anions in the lumen cause an increase in K+ secretion by increasing both the negativity of the lumen and the electrical driving force for K+ secretion.
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