The Cardiovascular
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Transtubular Potassium Gradient (TTKG)

Assesses renal potassium handling in dyskalemia.

Transtubular Potassium Gradient (TTKG)
Urine potassium
mEq/L
Serum potassium
mEq/L
Urine osmolality
mOsm/kg
Serum osmolality
mOsm/kg
Complete the fields above to see the result.

When to use

  • Distinguishing renal from extrarenal causes of hyper- or hypokalemia by estimating cortical collecting duct potassium secretion.

Formula

TTKG = (urine K x serum osmolality) / (serum K x urine osmolality).

Pearls and pitfalls

  • Only valid when urine osmolality exceeds serum osmolality and urine sodium is >25 mEq/L.
  • The validity of TTKG has been questioned; interpret alongside other measures.

References

  1. Ethier JH, et al. Am J Kidney Dis. 1990;15(4):309-15.