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Familial Hyperkalemic Hypertension (FHHt)

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Hydro Saline Metabolism

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

Familial Hyperkalemic Hypertension (FHHt) syndrome, also known as Gordon syndrome or Pseudohypoaldosteronism type II, is a very rare genetic form of hypertension associated with hyperkalemia and hyperchloremic metabolic acidosis, low renin and a normal GFR. These disorders are all corrected by thiazide diuretics that inhibit the Na+-Cl NCC cotransporter expressed in the distal convoluted tubule of the nephron. The sensitivity of FHHt patients to thiazide diuretics strongly suggested that FHHt is caused by an excessive sodium-chloride reabsorption by NCC. However, no mutations in the SLC12A3 gene, encoding NCC, were discovered in FHHt patients. Mutations were first identified in the genes encoding the serine-threonine kinases WNK1 and WNK4 [With No (K) lysine] and then in genes encoding components of a ubiquitin ligase complex, cullin-3 (CUL3), and Kelch-like family member 3 (KLHL3). Subsequent in vitro and in vivo studies have demonstrated that NCC is stimulated by a signaling pathway activated by WNK1 and WNK4, which are themselves targeted for proteosomal degradation by the Cul3-KLHL3 complex.

Therefore, the study of this very rare and easily treatable syndrome has led to the discovery of a new, unsuspected molecular pathway responsible for the regulation of ion handling in the distal nephron. In this chapter, we will describe how thus pathway was discovered and how these studies have allowed to understand how sodium reabsorption by the distal nephron is modulated by both sodium and potassium intakes to maintain blood pressure and plasma potassium balance.

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Rafael, C., Hadchouel, J. (2023). Familial Hyperkalemic Hypertension (FHHt). In: Caprio, M., Fernandes-Rosa, F.L. (eds) Hydro Saline Metabolism. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-27119-9_4

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