[Secondary gout and pseudo-Bartter syndrome in females with laxative abuse]

Elevated salivary uric acid levels among adolescents with eating disorders

OBJECTIVE

Uric acid (UA) is increasingly recognized as having important physiological roles and associated with several peripheral and central pathophysiological outcomes, and might play a role in eating disorders (ED) pathogenesis. We investigated whether UA levels are altered among adolescents with ED.

METHODS

Morning salivary UA concentrations were compared between adolescents referred to treatment at the Herman Dana Center receiving a DSM-V diagnosis of an ED and matched healthy controls.

RESULTS

Salivary UA was significantly elevated among ED compared with control values (ED mean 3.9 ± 1.2 mg/dl, control mean 2.9 ± 1.9 mg/dl, t = - 3.13 df = 81, p = 0.003).

DISCUSSION

Salivary UA is elevated among adolescents with ED. Further studies are required to replicate and extend this finding and evaluate its generalizability as a state or trait marker as regards ED subtypes, other body fluids (plasma and cerebrospinal fluid), and recovery or premorbid stages, as well as its putative mechanistic relevance to ED.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Pregnancy in a patient with gouty arthritis secondary to pseudo-Bartter syndrome

A 32-year-old woman with pseudo-Bartter syndrome secondary to excessive use of laxatives, presented with hypokalemia, metabolic alkalosis, hyperuricemia, and gouty arthritis with tophi. Subsequently the patient became pregnant and displayed recurrent severe gouty flares of multiple joints. Monosodium urate crystals were aspirated from the knee confirming the diagnosis of gout. Previous reports have stated an association between Bartter syndrome and gout, but this is the first case report of a pregnancy with active gouty arthritis combined with pseudo-Bartter syndrome.

Ammonium urate nephrolithiasis in a variant of Bartter's syndrome with intact renal tubular function

In two patients with Bartter's syndrome proximal tubular function and distal chloride reabsorption were intact on admission; however, chloride reabsorption and distal tubular acidifying capacity decreased in one patient over a period of 10 years. Renal prostaglandin E excretion and urinary and plasma uric acid were in the normal range, but urinary ammonium was significantly elevated during controlled diet. One patient developed ammonium urate nephrolithiasis. In both patients renal biopsy demonstrated lymphocytic infiltration of the interstitial tissue and hypercellularity of the macula densa. Indomethacin treatment improved serum potassium concentration and decreased plasma renin activity, plasma aldosterone concentration, and urinary prostaglandin E but had to be discontinued because of side effects. It is likely that our patients represent a variant form of the syndrome originally described by Bartter.