Hypokalemic Nephropathy: Case Report

Hypokalemic nephropathy is a rare tubulointerstitial disorder due to chronic hypokalemia that can lead to serious morphological or functional renal alterations. We report a case of a 31-year-old patient from North Africa, admitted to the Department of Nephrology for exploration of proteinuria at 1.2g/24h associated with renal failure at 21mg/l of plasma creatinine in a context of chronic hypokalemia around 2.5mEq/l. The nephropathy check up didn’t show anything particular. The renal biopsy performed revealed renal tubes with vacuolation of the epithelium, with the presence of a few hyaline casts. The interstitial tissue showed minimal fibrosis and a moderate inflammatory infiltrate composed of lymphocytes and histiocytes, all easing the diagnosis of hypokalemic nephropathy. The patient was treated with potassium supplementation in combination with an angiotensin converting enzyme inhibitor (ACE inhibitor). The evolution was marked by a progressive improvement of renal function going from an glomerular filtration rate (GFR) of 28 ml/min (at admission) to 55 ml/min after 6 months, with negativation of proteinuria. Although the hypokalemic nephropathy seems to have disappeared, it must be considered in the face of any alteration of renal function in a context of chronic hypokalemia. Histology is essential to confirm the diagnosis.