Ttkg transtubular potassium gradient acronymfinder. The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. Another index that has been proposed for the evaluation of urinepotassium loss is the transtubular potassium gradient ttkg. To determine the postnatal changes in mineralocorticoid action on the cortical distal nephron in preterm neonates, we evaluated the transtubular potassium gradient ttkg and its relationship to other renal and nonrenal parameters in 16 preterm neonates during the first 5 weeks of life. Transtubular potassium concentration gradient as a. This is a health tool that offers information regarding the conservation. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia jean h. Hyperkalemia is common in patients with cardiovascular disease. Recently, transtubular potassium gradient ttkg, a new and simple index, has. Serum and urine electrolyte levels, serum creatinine, renin, aldosterone, and cortisol levels were measured, and the transtubular potassium gradient was calculated. It is advantageous to make an independent assessment of the potassium k secretory process and the luminal flow rate in the renal cortex to evaluate k handling by the kidney during hypokalemia or hyperkalemia. Aug 07, 2018 the standard for clinical calculations and analytics in medicine.
Laboratory tests to determine the cause of hypokalemia and. Transtubular potassium gradient how is transtubular potassium gradient abbreviated. Based on the findings of hyperkalemia with low urine potassium secretion, low aldosterone action was highly suspected. In the face of hyperkalemia, a low ttkg transtubular potassium concentration gradient ttkg is a semiquantitative index of the activity of the k secretory process. The transtubular potassium gradient calculator evaluates the conservation of potassium in the collecting ducts of the kidney. Oct 01, 2014 read transtubular potassium gradient ttkg as a surrogate for monitoring aldosterone bioactivity in patients with acute decompensated heart failure, journal of cardiac failure on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Preterm neonates were divided into two groups according to their gestational age. The transtubular potassium gradient in the cortical collecting duct is an index reflecting conservation of potassium. Another index that has been proposed for the evaluation of urine potassium loss is the transtubular potassium gradient ttkg.
Read transtubular potassium gradient ttkg as a surrogate for monitoring aldosterone bioactivity in patients with acute decompensated heart failure, journal of cardiac failure on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Answering your questions her renin level was transtubular potassium gradient was 17 high. Patients should address specific medical concerns with their physicians. Its portability, comprehensiveness, and ease of access makes it a favorite oncall resource for housestaff. Transtubular potassium gradient ttkg u k x p osm p k x u osm. Although access to this page is not restricted, the information found here is intended for use by medical providers. Therefore, we evaluated the diagnostic value of spot urine tests in patients with hypokalemia and paralysis during 3 years. It has been concluded that the ttkg is not a reliable test to help differentiate the causes of hyperkalemia. The calx are linked to the dynamic tables for visually. The purpose of this study was to define expected values for the ttkg in normal subjects with hypokalemia or following an acute k load. K in the ccd in humans using the transtubular k concentration gradient ttkg, a semiquantitative index of secretion of k in the terminal ccd.
A mathematical model of rat cortical collecting duct. Halperin, md it is advantageous to make an independent assessment of the potassium k secretory process and the luminal flow rate in the renal cortex to evaluate k handling by the kidney during hypokalemia. Methods before therapy, the urine potassium concentration, potassium creatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample. Hendersonhasselbalch osmolal gap detect unmeasured osmoles, such as toxic alcohols transtubular k gradient workup hypokalemia and hyperkalemia water deficit in hypernatremia determine water replacement in hypernatremia volume of distribution of urea calcium correction for hypoalbuminemia adjust serum calcium in the setting of low albumin total. It is useful in diagnosing the causes of hyperkalemia or hypokalemia. Transtubular potassium gradient delta delta, hco3 deficit henderson. Transtubular potassium gradient at ccd the merck manuals. Renal mechanism of trimethopriminduced hyperkalemia. The utility of the transtubular potassium gradient in the.
Furthermore, to ensure correct calculation of the transtubular potassium gradient ttkg, we excluded another 292 patients with random urine sodium less than 25 mmoll and those with urine osmolality less than the plasma osmolality. For this study, we additionally excluded 158 patients without data for urinary agt levels. Transtubular potassium concentration gradient as a surrogate. The transtubular potassium gradient ttkg is utilized to held determine whether the renal response to hyperkalemia or hypokalemia is appropriate. The transtubular potassium concentration gradient ttkg has been reported to be a marker of renal. Read transtubular potassium concentration gradient. Transtubular potassium gradient ttkg was developed to account for the potentially confounding effect of urine concentration on the interpretation of the urine potassium concentration. Trans tubular potassium gradient from touchcalc programmed by stephen z. Family practice notebook 2020, family practice notebook, llc. A normal ttkg in normal subjects on normal diets is 89. The calx are linked to the dynamic tables for visually efficient point.
The transtubular potassium concentration gradient ttkg has been reported to be a marker of renal aldosterone bioactivity. It adjusts the urinary potassium for the concentrating effects that occur in the collecting tubule, where water is removed from the urine. Transtubular potassium concentration gradient in preterm. This study tested the hypothesis that ttkg can be a surrogate of arterial underfilling in patients with adhf. Modulation of the secretion of potassium by accompanying. West ml, bendz o, chen cb, singer gg, richardson rma, sonnenberg h, halperin ml 1986 development of a test to evaluate the transtubular potassium concentration gradient in the cortical collecting duct in vivo. Transtubular potassium gradient ttkgu potassium p potassiumu osmp osm. Transtubular potassium gradient ttkg peripheral brain. The transtubular potassium gradient ttkg derived from the urineplasma potassium ratio divided by the urineplasma osmolality ratio has been popularized 12. Transtubular potassium gradient in patients with drug. By comparing the k concentration in the kidney ducts with that from the peritubular capillaries, ttkg can help with the differential diagnosis of hyperkalemia and hypokalemia. The transtubular potassium gradient ttkg is used to gauge renal potassium secretion by the cortical collecting duct, indirectly assessing mineralocorticoid. The utility of the transtubular potassium gradient in the evaluation. Methods before therapy, the urine potassium concentration, potassiumcreatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample.
The transtubular potassium gradient ttkg is an index reflecting the conservation of. Request pdf transtubular potassium concentration gradient ttkg and urine ammonium in differential diagnosis of hypokalemia. The standard for clinical calculations and analytics in medicine. Transtubular potassium gradient ttkg formula renal. Transtubular potassium gradient how is transtubular. The purpose of these investigations was to develop a noninvasive test to estimate the transtubular potassium concentration gradient ttkg and thereby aldosterone action in the late distal convoluted tubule and the cortical collecting duct in patients with disorders of potassium excretion. It is useful in diagnosing the cause of hyperkalemia. Ttkg urine k plasmaosm plasma k urineosm where, ttkg transtubular potassium gradient urine k urine potassium in meql or mmoll plasma k plasma potassium in meql or. It is represented mathematically as the urinary potassium concentrationplasma potassium concentration, all divided by the.
The ttkg is used clinically to determine the cause of high serum potassium levels. Monitoring of transtubular potassium gradient in the diuretic management of patients with cirrhosis and ascites. Further more, to ensure correct calculation of the transtubular potassium gradient ttkg, we excluded another 292 pa tients with random urine sodium less than 25 mmoll and those with urine. Transtubular potassium gradient ttkg is an index reflecting the conservation of potassium in the cortical collecting ducts of the kidneys. Its consequences can be severe and lifethreatening, and its management and prevention require a multidisciplinary approach that entails reducing intake of high potassium foods, adjusting medications that cause hyperkalemia, and adding medications that reduce the plasma potassium concentration.
In the face of hyperkalemia, a low ttkg transtubular potassium gradient in the evaluation of hyperkalemia. The transtubular potassium concentration in patients with. It is the dedication of healthcare workers that will lead us through this crisis. The transtubular potassium gradient ttkg is used to gauge renal potassium secretion by the cortical collecting duct, indirectly assessing mineralocorticoid bioactivity in patients who have hypo or hyperkalemia. In assessing disorders of potassium excretion, urine composition is used to calculate the transtubular gradient ttkg, as an estimate of tubule fluid concentration, at a point when the fluid was last isotonic to plasma, namely, within the cortical collecting duct ccd. The effects of trimethoprim infusion on urinary sodium, chloride. Transtubular potassium concentration gradient ttkg and urine. The next step to analyse is the rate of excretion of. We studied the impact of high mineralocorticoid activity versus. Transtubular potassium gradient definition of transtubular. This transtubular potassium gradient ttkg calculator is based on the kidney index helping in the differential diagnosis of hyperkalemia and hypokalemia.
Fractional excretion of sodium fe na u na x p cr p na x u cr x 100. Answering your questions 5 miul low, aldosterone was 2 234 pmoll high and her transtubular potassium gradient was 17 high. Diagnosis and treatment of hyperkalemia cleveland clinic. Transtubular potassium gradient ttkg when should it be used. These images are a random sampling from a bing search on the term transtubular potassium gradient. Thanks to vaibhav for presenting a case of a middleaged man with postoperative hyperkalemia, found to have a type 4 rta.
Established for over 40 years as the bible of the medical ward, the washington manual of medical therapeutics is now in its thirtythird edition and builds upon that proud traditionwith even more of the current information you need, delivered in a timesaving, quickreference style. In the face of hyperkalemia, a low ttkg 2 during hypokalemia point to renal loss. The transtubular potassium gradient ttkg is an index reflecting the conservation of potassium in the cortical collecting ducts ccd of the kidneys. Ttkg values 2 during hypokalemia point to renal loss. The transtubular potassium concentration gradient ttkg is a semiquantitative index of the activity of the k secretory process. Several indirect indices of mineralocorticoid activity based on renal electrolyte excretion have been proposed and include the transtubular potassium gradient, urinary kna ratio, and renal fractional excretion of potassium. Ttkg urine k plasmaosm plasma k urineosm where, ttkg transtubular potassium gradient urine k urine potassium in meql or. Transtubular potassium gradient in patients with druginduced hyperkalemia. The transtubular potassium gradient ttkg is a formula used to assess renal handling of potassium. Effect of mineralocorticoid activity on transtubular.
The transtubular potassium gradient ttkg determines etiology of hyperkalemia or hypokalemia. Urinary angiotensinogen level is associated with potassium. You can find more information on the ttkg index results and the variables involved in the text placed under the form. Transtubular potassium gradient ttkg calculator medical. Clinical assessment of potassium derangements may require evaluation of mineralocorticoid status. Download pretitle the washington manual of medical therapeutics posttitle from mediafire, rapishare, and mirror link established for over 40 years as the bible of the medical ward, the washington manual of medical therapeutics is now in its thirtythird edition and builds upon that proud traditionwith even more of the current information you need, delivered in a timesaving, quick. Click on the image or right click to open the source website in a new browser window. The ttkg estimates the ratio of potassium in the lumen of the ccd to that in the peritubular capillaries. Answering your questions her renin level was pdf download.
Richardson rma, sonnenberg h, halperin ml 1986 development of a test to evaluate the transtubular potassium concentration gradient in the cortical collecting. Development of a test to evaluate the transtubular. Transtubular potassium gradient ttkg is controversial but may be used for evaluation of hyperkalemia etiology ie. In a logical, stepwise approach to patients presenting with hypokalaemia or hyperkalaemia the clinician must first recognise circumstances in which the dyskalaemia represents a clinical emergency because therapy then takes precedence over diagnosis. We measured ttkg at discharge in 100 adhf patients. The transtubular potassium gradient ttkg was historically recommend for assessing hyperkalemia but the original studiess assumptions were proven invalid.
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