Increased potassium levels in the context of decreased GFR may indicate which condition?

Increased potassium levels, or hyperkalemia, often occur in the context of decreased glomerular filtration rate (GFR) due to the kidneys' reduced ability to excrete potassium. Acute kidney injury (AKI) is characterized by a sudden decline in renal function, which can lead to impaired regulation of electrolytes, including potassium. In this situation, as the kidneys become less effective in filtering blood, excess potassium accumulates in the bloodstream, resulting in elevated serum potassium levels.

In contrast, while heart failure can affect kidney function and potassium levels, it is not directly responsible for the hyperkalemia observed specifically due to decreased GFR. Chronic liver disease may also impact electrolyte balance, but it typically does not cause hyperkalemia solely due to decreased GFR; rather, disturbances arise from other metabolic processes. Similarly, pernicious anemia primarily affects red blood cell production and does not have a direct relationship with potassium regulation or GFR impairment.

Thus, the context of acute kidney injury directly leading to increased potassium levels due to decreased GFR makes it the most relevant and accurate condition associated with the described electrolyte imbalance.