In this issue, Ritz and Pitt discuss mineralocorticoid-receptor blockade in patients with chronic kidney disease (CKD), the propensity to develop hyperkalaemia, and present a novel suggestion of what to do about it. Actually, the risk of hyperkalaemia in CKD patients may be less of a lethal problem than hypokalaemia; however, hyperkalaemia seems to pack the imagination of clinicians more than h...

Introduction Spironolactone is a specific competitive antagonist of aldosterone, the most potent endogenous mineralocorticoid, which modifies renal electrolyte handling and is therefore commonly used as a diuretic in conditions associated with secondary hyperaldosteronism. In renal insufficiency, aldosterone antagonists may induce significant hyperkalaemia even if administered concurrently with...

Secondary hyperkalaemic paralysis is a rare condition often mimicking the Guillain-Barré syndrome. There have been a few case reports of hyperkalaemia caused by renal failure, trauma, and drugs where the presentation has been with muscle weakness. A case of hyperkalaemic paralysis caused by an angiotensin converting enzyme inhibitor is reported.

Six patients with severe refractory hypertension and chronic renal failure were treated with a low dose of captopril (mean daily dose 75 mg) in combination with dietary sodium restriction, frusemide and either metoprolol, labetalol or prazosin. Sustained control of blood pressure was achieved in all six patients. Adverse effects noted were severe hyperkalaemia (2 patients), skin rashes (2 patie...