The ROMK channel plays an important role in K recycling in the thick ascending limb (TAL) and K secretion in the cortical collecting duct (CCD). A large body of evidence indicates that the ROMK channel is a key component of the native K secretory channel identified in the apical membrane of the TAL and the CCD. Although the ROMK channel shares several key regulatory mechanisms with the native K secretory channel in a variety of respects, differences in the channel modulatory mechanism are clearly present between the ROMK channel and the native K secretory channel. Therefore, it is possible that additional associate proteins are required to interact with the ROMK channel to assemble the native K secretory channel. This notion is supported by recent reports showing that cystic fibrosis transmembrane conductance regulator (CFTR) and A kinase anchoring proteins (AKAP) interact with the ROMK channels to restore the response to ATP sensitivity and protein kinase A stimulation. This review is an attempt to summarize the up-to-date progress regarding the interaction between the ROMK channel and the associate proteins in forming the native K secretory channel.