Hyperkalemia In Chronic Renal Failure

To the Editor:— The rarity of the spontaneous development of severe hyperkalemia in nonoliguric chronic renal failure is poorly appreciated. Among the many reports of hyperkalemia in renal insufficiency we have not found a well-documented case of life-threatening hyperkalemia in a patient with stable chronic uremia without oliguria, sodium depletion, excessive potassium load, adrenal insufficiency, or other precipitating cause. We are now treating a patient with chronic glomerulonephritis in which there is a tendency for dangerous hyperkalemia to develop. Report of a Case:— In 1959, signs of acute glomerulonephritis after a streptococcal sore throat developed in a 30-year-old white man. Progressive renal deterioration ensued. For the past two years the blood urea nitrogen (BUN) level has stabilized in the 120-140 mg/100 cc range. His medications have been methyldopa, hydralazine, and digoxin. He has been emaciated and hyperpigmented and has suffered constant fatigue. His hemoglobin level has slowly fallen to 6.6