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Potassium Losing Pyelonephritis Response to Spironolactone

Alan R. Gerstein, MD; Stanley S. Franklin, MD; Charles R. Kleeman, MD; Morton H. Maxwell, MD; Ernest M. Gold, MD
Arch Intern Med. 1969;123(1):55-57. doi:10.1001/archinte.1969.00300110057010.
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Reports of "potassium losing pyelonephritis"1 have practically disappeared from the medical literature since the discovery of aldosterone. Cases that might have been reported as potassium losing pyelonephritis previously are now found to be primary hyperaldosteronism with superimposed urinary tract infection. There is some evidence that hypokalemic nephropathy may predispose to infection of the kidney.2-4 Nevertheless, cases of urinary potassium wasting with probable pyelonephritis in the absence of excessive aldosterone excretion have been reported 5,6; in one instance potassium wasting ended with treatment of the infection.7

We have studied a patient with mild but symptomatic renal potassium wasting, biopsy proven pyelonephritis, and apparently normal aldosterone production. Spironolactone administration prevented potassium loss indicating a role of aldosterone despite the absence of "hyperaldosteronism."

Patient Summary  This 74-year-old white man was first seen because of postural hypotension. Dysuria and weak urinary stream had been present for eight years. One year before


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