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Pseudohypoaldosteronism type 2

Reviewed December 2011

What is pseudohypoaldosteronism type 2?

Pseudohypoaldosteronism type 2 (PHA2) is a condition characterized by problems regulating the amount of sodium and potassium in the body. Sodium and potassium are important in the control of blood pressure, and their regulation occurs primarily in the kidneys.

People with PHA2 have high blood pressure (hypertension) and high levels of potassium in their blood (hyperkalemia) despite having normal kidney function (normal glomerular filtration rate). The age of onset of the condition is variable and difficult to pinpoint; some affected individuals are diagnosed in infancy or childhood, and others are diagnosed in adulthood. Hyperkalemia usually occurs first, and hypertension develops later in life. Affected individuals may also have high levels of chloride (hyperchloremia) or acid (metabolic acidosis) in their blood. People with hyperkalemia, hyperchloremia, and metabolic acidosis can have nonspecific symptoms like nausea, vomiting, extreme tiredness (fatigue), and muscle weakness.

How common is pseudohypoaldosteronism type 2?

PHA2 is a rare condition; however, the prevalence is unknown.

What genes are related to pseudohypoaldosteronism type 2?

Mutations in either of two related genes, WNK1 and WNK4, can cause PHA2. These genes play a role in regulating blood pressure by helping to control the amount of sodium and potassium in the body. The proteins produced from the WNK1 and WNK4 genes act as kinases, which are enzymes that change the activity of other proteins by adding a cluster of oxygen and phosphorus atoms (a phosphate group) at specific positions.

The WNK1 and WNK4 proteins regulate channels in the cell membrane that control the transport of sodium or potassium into and out of cells, which occurs primarily in the kidneys. Sodium channels help transport sodium into specialized cells of the kidney, from which it is transferred to the blood. This transfer helps keep sodium in the body through a process called reabsorption. Potassium channels handle excess potassium that has been transferred from the blood into the kidney cells. The channels transport the potassium out of the cells in a process called secretion, so that it can be removed from the body in the urine.

The WNK4 protein normally blocks (inhibits) sodium and potassium channels, which decreases sodium reabsorption and potassium secretion. The WNK1 protein normally stops WNK4's inhibition of sodium channels, which increases sodium reabsorption. The WNK1 protein also inhibits potassium channels, which decreases potassium secretion.

Mutations in the WNK1 gene increase the activity of the gene and lead to excess WNK1 protein. The excess protein abnormally increases sodium reabsorption and blocks potassium secretion. These effects lead to increased sodium and potassium levels in the body, causing hypertension and hyperkalemia.

Mutations in the WNK4 gene lead to an abnormal protein that no longer inhibits sodium channels but inhibits potassium channels more strongly. Like WNK1 gene mutations, mutations in the WNK4 gene lead to increased sodium reabsorption and decreased potassium secretion, resulting in hypertension and hyperkalemia.

Related Gene(s)

Changes in these genes are associated with pseudohypoaldosteronism type 2.

  • WNK1
  • WNK4

How do people inherit pseudohypoaldosteronism type 2?


Where can I find information about diagnosis or management of pseudohypoaldosteronism type 2?

These resources address the diagnosis or management of pseudohypoaldosteronism type 2 and may include treatment providers.

  • Gene Review: Pseudohypoaldosteronism Type II (

You might also find information on the diagnosis or management of pseudohypoaldosteronism type 2 in Educational resources ( and Patient support (



Where can I find additional information about pseudohypoaldosteronism type 2?

You may find the following resources about pseudohypoaldosteronism type 2 helpful. These materials are written for the general public.


What other names do people use for pseudohypoaldosteronism type 2?

  • familial hyperpotassemia and hypertension
  • familial hypertensive hyperkalemia
  • Gordon hyperkalemia-hypertension syndrome
  • pseudohypoaldosteronism type II


What if I still have specific questions about pseudohypoaldosteronism type 2?

Ask the Genetic and Rare Diseases Information Center (

What glossary definitions help with understanding pseudohypoaldosteronism type 2?

acidosis ; autosomal ; autosomal dominant ; cell ; cell membrane ; chloride ; familial ; gene ; hyperkalemia ; hyperpotassemia ; hypertension ; inherited ; kidney ; oxygen ; phosphate ; phosphorus ; potassium ; prevalence ; protein ; secretion ; sodium ; syndrome



  • McCormick JA, Ellison DH. The WNKs: atypical protein kinases with pleiotropic actions. Physiol Rev. 2011 Jan;91(1):177-219. doi: 10.1152/physrev.00017.2010. Review. (
  • Moriguchi T, Urushiyama S, Hisamoto N, Iemura S, Uchida S, Natsume T, Matsumoto K, Shibuya H. WNK1 regulates phosphorylation of cation-chloride-coupled cotransporters via the STE20-related kinases, SPAK and OSR1. J Biol Chem. 2005 Dec 30;280(52):42685-93. Epub 2005 Oct 31. (
  • Ring AM, Cheng SX, Leng Q, Kahle KT, Rinehart J, Lalioti MD, Volkman HM, Wilson FH, Hebert SC, Lifton RP. WNK4 regulates activity of the epithelial Na+ channel in vitro and in vivo. Proc Natl Acad Sci U S A. 2007 Mar 6;104(10):4020-4. Epub 2007 Feb 26. (
  • Subramanya AR, Liu J, Ellison DH, Wade JB, Welling PA. WNK4 diverts the thiazide-sensitive NaCl cotransporter to the lysosome and stimulates AP-3 interaction. J Biol Chem. 2009 Jul 3;284(27):18471-80. doi: 10.1074/jbc.M109.008185. Epub 2009 Apr 28. (
  • Wilson FH, Disse-Nicodème S, Choate KA, Ishikawa K, Nelson-Williams C, Desitter I, Gunel M, Milford DV, Lipkin GW, Achard JM, Feely MP, Dussol B, Berland Y, Unwin RJ, Mayan H, Simon DB, Farfel Z, Jeunemaitre X, Lifton RP. Human hypertension caused by mutations in WNK kinases. Science. 2001 Aug 10;293(5532):1107-12. (
  • Wilson FH, Kahle KT, Sabath E, Lalioti MD, Rapson AK, Hoover RS, Hebert SC, Gamba G, Lifton RP. Molecular pathogenesis of inherited hypertension with hyperkalemia: the Na-Cl cotransporter is inhibited by wild-type but not mutant WNK4. Proc Natl Acad Sci U S A. 2003 Jan 21;100(2):680-4. Epub 2003 Jan 6. (



Reviewed: December 2011
Published: December 22, 2014