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Dorsett D. The Drosophila melanogaster model for Cornelia de Lange syndrome: Implications for etiology and therapeutics. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:129-37. [PMID: 27097273 DOI: 10.1002/ajmg.c.31490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Discovery of genetic alterations that cause human birth defects provide key opportunities to improve the diagnosis, treatment, and family counseling. Frequently, however, these opportunities are limited by the lack of knowledge about the normal functions of the affected genes. In many cases, there is more information about the gene's orthologs in model organisms, including Drosophila melanogaster. Despite almost a billion years of evolutionary divergence, over three-quarters of genes linked to human diseases have Drosophila homologs. With a short generation time, a twenty-fold smaller genome, and unique genetic tools, the conserved functions of genes are often more easily elucidated in Drosophila than in other organisms. Here we present how this applies to Cornelia de Lange syndrome, as a model for how Drosophila can be used to increase understanding of genetic syndromes caused by mutations with broad effects on gene transcription and exploited to develop novel therapies. © 2016 Wiley Periodicals, Inc.
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Kornerup HJ, Pedersen EB, Petersen VP. Bartter's syndrome without hyperplasia of the juxtaglomerular apparatus, treated with indomethacin. ACTA MEDICA SCANDINAVICA 2009; 204:235-9. [PMID: 696424 DOI: 10.1111/j.0954-6820.1978.tb08430.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present report describes a case of potassium-wasting nephropathy with the physiological and endocrinological findings that are typical for Bartter's syndrome (BS). However, the renal juxtaglomerular apparatus showed no hyperplasia at two renal biopsies two years apart. The short-term (9 days) effect of indomethacin in combination with spironolactone was a suppression of hyperreninemia and hyperaldosteronism and an increase in vascular sensitivity to angiotensin II associated with potassium and sodium retention. Subsequently, on indomethacin alone, potassium balance was obtained on a lower level with persistent hypokalemia and persistent renal potassium leakage. Hypokalemia persisted during long-term (9 months) treatment with indomethacin despite normalization of the activity of the renin-aldosterone system. The results indicate that indomethacin as long-term treatment may be ineffective in maintaining a normal potassium balance in BS.
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Nielsen I, Hesse B, Christensen P. On the pathogenetic role of prostaglandins in Bartter's syndrome. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 625:135-40. [PMID: 285569 DOI: 10.1111/j.0954-6820.1979.tb00758.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two patients, one with Bartter's syndrome and one with severe abuse of diuretics, were investigated before and after indomethacin treatment. Before indomethacin the two patients showed a similar pattern of hypokalaemic alcalosis, secondary hyperaldosteronism, and increased urinary excretion of PGE2 and kallikrein. After a few days on peroral indomethacin medication the hypokalaemia was significantly improved, the plasma renin activity, and the urinary excretion of aldosterone, PGE2 and kallikrein were normalized in both patients. It is concluded that the beneficial effect of indomethacin cannot be used as a proof of prostaglandin overproduction as the primary defect in Bartter's syndrome.
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Park HW, Lee JH, Park YS. The clinical manifestations, the short- and long-term outcomes of Bartter syndrome. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.12.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hye Won Park
- Departments of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hoon Lee
- Departments of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seo Park
- Departments of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jeck N, Schlingmann KP, Reinalter SC, Kömhoff M, Peters M, Waldegger S, Seyberth HW. Salt handling in the distal nephron: lessons learned from inherited human disorders. Am J Physiol Regul Integr Comp Physiol 2005; 288:R782-95. [PMID: 15793031 DOI: 10.1152/ajpregu.00600.2004] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The molecular basis of inherited salt-losing tubular disorders with secondary hypokalemia has become much clearer in the past two decades. Two distinct segments along the nephron turned out to be affected, the thick ascending limb of Henle's loop and the distal convoluted tubule, accounting for two major clinical phenotypes, hyperprostaglandin E syndrome and Bartter-Gitelman syndrome. To date, inactivating mutations have been detected in six different genes encoding for proteins involved in renal transepithelial salt transport. Careful examination of genetically defined patients (“human knockouts”) allowed us to determine the individual role of a specific protein and its contribution to the overall process of renal salt reabsorption. The recent generation of several genetically engineered mouse models that are deficient in orthologous genes further enabled us to compare the human phenotype with the animal models, revealing some unexpected interspecies differences. As the first line treatment in hyperprostaglandin E syndrome includes cyclooxygenase inhibitors, we propose some hypotheses about the mysterious role of PGE2in the etiology of renal salt-losing disorders.
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Affiliation(s)
- Nikola Jeck
- MD, Univ. Children's Hospital, Philipps-Univ., Deutschhausstrasse 12, D-35037 Marburg, Germany. )
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Shaer AJ. Inherited primary renal tubular hypokalemic alkalosis: a review of Gitelman and Bartter syndromes. Am J Med Sci 2001; 322:316-32. [PMID: 11780689 DOI: 10.1097/00000441-200112000-00004] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Inherited hypokalemic metabolic alkalosis, or Bartter syndrome, comprises several closely related disorders of renal tubular electrolyte transport. Recent advances in the field of molecular genetics have demonstrated that there are four genetically distinct abnormalities, which result from mutations in renal electrolyte transporters and channels. Neonatal Bartter syndrome affects neonates and is characterized by polyhydramnios, premature delivery, severe electrolyte derangements, growth retardation, and hypercalciuria leading to nephrocalcinosis. It may be caused by a mutation in the gene encoding the Na-K-2Cl cotransporter (NKCC2) or the outwardly rectifying potassium channel (ROMK), a regulator of NKCC2. Classic Bartter syndrome is due to a mutation in the gene encoding the chloride channel (CLCNKB), also a regulator of NKCC2, and typically presents in infancy or early childhood with failure to thrive. Nephrocalcinosis is typically absent despite hypercalciuria. The hypocalciuric, hypomagnesemic variant of Bartter syndrome (Gitelman syndrome), presents in early adulthood with predominantly musculoskeletal symptoms and is due to mutations in the gene encoding the Na-Cl cotransporter (NCCT). Even though our understanding of these disorders has been greatly advanced by these discoveries, the pathophysiology remains to be completely defined. Genotype-phenotype correlations among the four disorders are quite variable and continue to be studied. A comprehensive review of Bartter and Gitelman syndromes will be provided here.
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Affiliation(s)
- A J Shaer
- Division of Nephrology, Medical University of South Carolina, Charleston 29425, USA.
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Affiliation(s)
- I Kurtz
- UCLA School of Medicine, Los Angeles, California, USA
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Köckerling A, Reinalter SC, Seyberth HW. Impaired response to furosemide in hyperprostaglandin E syndrome: evidence for a tubular defect in the loop of Henle. J Pediatr 1996; 129:519-28. [PMID: 8859258 DOI: 10.1016/s0022-3476(96)70116-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In hyperprostaglandin E syndrome (HPS) renal wasting of electrolytes and water is consistently associated with enhanced synthesis of prostaglandin E2. In contrast to Bartter or Gitelman syndrome (BS/GS), HPS is characterized by its severe prenatal manifestation, leading to fetal polyuria, development of polyhydramnios, and premature birth. This disorder mimics furosemide treatment with hypokalemic alkalosis, hypochloremia, isosthenuria, and impaired renal conservation of both calcium and magnesium. Therefore the thick ascending limb of the loop of Henle seems to be involved in HPS. To characterize the tubular defect we investigated the response to furosemide (2 mg/kg) in HPS (n = 8) and BS/GS (n = 3) 1 week after discontinuation of long-term indomethacin treatment. Sensitivity to furosemide was completely maintained in patients with BS/GS. The diuretic, saluretic, and hormonal responses were similar to those of a control group of healthy children (n = 13), indicating an intact function of the thick ascending limb of the loop of Henle in BS/GS. In contrast, patients with HPS had a marked resistance to this loop diuretic. Furosemide treatment increased urine output by 7.5 +/- 0.7 ml/kg per hour in healthy control subjects but only by 4.4 +/- 1.2 ml/kg per hour (p < 0.5) in children with HPS. In parallel, the latter also had a markedly impaired saluretic response (delta Cl(urine) 0.14 +/- 0.04 mmol/kg per hour vs 0.85 +/- 0.09 mmol/kg per hour, p < 0.001; delta Na(urine) 0.23 +/- 0.06 mmol/kg per hour vs 0.77 +/- 0.09 mmol/kg per hour, p < 0.001). Furosemide therapy further enhanced prostaglandin E2 excretion in patients with HPS (54 +/- 17 to 107 +/- 28 ng/hr per 1.73 m2, p < 0.05), whereas no significant effect was observed in healthy children (20 +/- 3 to 12 +/- 3 ng/hr per 1.73 m2). We conclude that a defect of electrolyte reabsorption in the thick ascending limb of the loop of Henle plays a major role in HPS.
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Affiliation(s)
- A Köckerling
- Department of Pediatrics, Philipps University, Marburg, Germany
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Abstract
Bartter's syndrome is a congenital abnormality characterized by metabolic alkalosis [corrected], hyperreninemic hyperaldosteronism, and hypokalemia. Most patients present early in life with symptoms such as muscle weakness and polyuria, which may be attributed to potassium depletion. Despite the hyperaldosteronism, the patients tend to be normotensive, which is at least partially explained by vascular hyporesponsiveness to pressor hormones. Numerous studies have documented increased renal excretion of prostaglandins. Several different patterns of aberrant renal ion transport have been observed in patients with the syndrome, suggesting that it actually may represent a family of related but distinct tubular disorders. Therapeutic approaches to Bartter's syndrome include potassium supplementation, prostaglandin synthesis inhibitors (nonsteroidal anti-inflammatory agents), aldosterone antagonists, and converting enzyme inhibitors. During the first two decades following its initial description, Bartter's syndrome was the focus of widespread interest, based on the likelihood that its investigation might provide insight into the normal functioning of the renin-angiotensin-aldosterone and prostanoid hormone systems. During the past decade, however, little additional progress has been made in Bartter's syndrome, and its patho-physiology remains poorly understood.
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Affiliation(s)
- D M Clive
- Department of Medicine, University of Massachusetts Medical Center, Worcester 01655, USA
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Abstract
Most renal transport is a primary or secondary result of the action of one of three membrane bound ion translocating ATPase pumps. The proximal tubule mechanisms for the reabsorption of salt, volume, organic compounds, phosphate, and most bicarbonate reabsorption depend upon the generation and maintenance of a low intracellular sodium concentration by the basolateral membrane Na-K-ATPase pump. The reabsorption of fluid and salt in the loop of Henle is similarly dependent on the energy provided by Na-K-ATPase activity. Some proximal tubule bicarbonate reabsorption and all distal nephron proton excretion is a product of one of two proton translocating ATPase pumps, either an electrogenic H-ATPase or an electroneutral H-K-ATPase. In this article, the authors review the biochemistry and physiology of pump activity and consider the pathophysiology of proximal and distal renal tubular acidosis, the Fanconi syndrome, and Bartter's syndrome as disorders of ATPase pump function.
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Affiliation(s)
- S Eiam-Ong
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430
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Abstract
Prostanoids belong to the growing family of eicosanoids, which are all derived from arachidonic acid. Prostanoids act as modulators and mediators in a large spectrum of physiological and pathophysiological processes within the kidney. On the one hand, the potent vasoconstrictor and platelet-aggregating thromboxane (TX) A2 is involved in the pathophysiology of a variety of glomerular diseases, such as haemolytic-uraemic syndrome and immune-mediated glomerulopathies. Prostaglandin (PG) E2, on the other hand, interferes with tubular electrolyte and water handling. Clinical data support the hypothesis that this member of the prostanoid family contributes to the pathophysiology of Bartter's syndrome, hyperprostaglandin E syndrome, idiopathic hypercalciuria and renal diabetes insipidus. Both prostanoids, TXA2 and PGE2, are involved in the pathophysiology of obstructive uropathies. The physiological and protective role of renal vasodilator prostanoids (PGI2 and PGE2) has been studied during treatment with non-steroidal anti-inflammatory drugs. Part of the pharmacological effects of frusemide and converting enzyme inhibitors is mediated by PGI2 and PGE2. The role of renal prostanoids in cyclosporine toxicity is still equivocal. Future investigations on the physiological and pathophysiological role of renal prostanoids will have to consider the multiple interactions between prostanoids on the one hand, and classical hormones and other mediators (e.g. cytokines) on the other hand.
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Affiliation(s)
- H W Seyberth
- Department of Paediatrics, University of Marburg, Federal Republic of Germany
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Clive DM, Stoff JS, Cardi M, MacIntyre DE, Brown RS, Salzman EW. Evidence that circulating 6keto prostaglandin E1 causes the platelet defect of Bartter's syndrome. Prostaglandins Leukot Essent Fatty Acids 1990; 41:251-8. [PMID: 2077538 DOI: 10.1016/0952-3278(90)90138-b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Bartter's syndrome is associated with activation of prostaglandin metabolism. In the present study we provide several lines of evidence that a circulating metabolite of prostacyclin, 6ketoPGE1 is responsible for a defect in platelet function present in patients with Bartter's syndrome. In platelet aggregometry studies, plasma from patients contained platelet inhibitory activity which was fully neutralized by coincubation with antibody directed against 6ketoPGE1. Fractionation of lipophilic extracts of plasma by high pressure liquid chromatography yielded a platelet inhibitory fraction which comigrated with authentic 6ketoPGE1 and was neutralized by anti 6ketoPGE1 antibody. Lastly, direct measure of the plasma concentration of 6ketoPGE1 by specific radioimmunoassay indicates a 2-fold increase in patients with Bartter's syndrome (133 +/- 9.1 vs 60.7 +/- 12.3 picograms/ml; p less than 025). These studies provide firm evidence that the platelet dysfunction present in patients with Bartter's syndrome is attributable to an increase in the plasma concentration of 6ketoPGE1. In addition, these data provide further evidence in support of the centrality of activation of prostaglandin metabolism in the pathophysiology of Bartter's syndrome.
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Affiliation(s)
- D M Clive
- Department of Medicine, University of Massachusetts Medical School, Worcester 01655
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Abstract
We here report a case of Bartter's syndrome occurring in association with diabetes mellitus. The patient, an insulin-dependent diabetic, presented with hypokalaemia, inappropriate kaliuresis and metabolic alkalosis. He had high plasma renin activity, relatively low plasma aldosterone, and resistance to infused angiotensin II. A high potassium diet raised total body potassium and serum potassium, did not affect plasma renin activity, but raised plasma aldosterone significantly and did not alter the resistance to angiotensin II. Indomethacin administered acutely reduced urinary potassium and kallikrein excretion and, on chronic administration, lowered plasma renin activity, urinary chloride excretion, and raised serum potassium. Salt restriction resulted in a prompt and significant reduction in urinary sodium and chloride excretion. Urinary kallikrein excretion was very high throughout, increased with sodium restriction, and decreased with sodium loading. Oral potassium supplementation partially corrected the hypokalaemia, but did not affect blood sugar control. In this patient the primary defect appears to have been primary urinary potassium wasting, rather than sodium or chloride wasting. The striking effects of indomethacin suggest that prostaglandins may play a fundamental role in the genesis of the syndrome.
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Affiliation(s)
- G Venkat Raman
- Department of Renal Medicine, University of Southhampton, UK
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Langhendries JP, Thiry V, Bodart E, Delfosse G, Whitofs L, Battisti O, Bertrand JM. Exogenous prostaglandin administration and pseudo-Bartter syndrome. Eur J Pediatr 1989; 149:208-9. [PMID: 2612511 DOI: 10.1007/bf01958284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Biological abnormalities simulating Bartter syndrome were observed in a preterm neonate with complex cyanotic congenital heart disease, for which ductus arteriosus was maintained open by high doses of prostaglandin (PG) until a Blalock shunt could be performed. These abnormalities spontaneously disappeared after cessation of PG administration. We postulate that the natriuretic effect of exogenous administered PG could further increase sodium wasting already induced by the cardiopathy thus leading to pseudo-Bartter syndrome.
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Affiliation(s)
- J P Langhendries
- Department of Paediatrics, Children's Hospital Montegnee-Rocourt, Belgium
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Abstract
Twenty-eight patients with Bartter's syndrome diagnosed during the years 1964-86 and followed for an average of 9.9 years have been reviewed. Their mean age at the time of diagnosis was 32.9 years. As a group they were shorter than normal subjects. In 19 patients hypokalaemia was detected incidentally. Neuromuscular symptoms, usually minor, had occurred in 19 subjects. Pregnancies and deliveries were unremarkable. One patient has died from malignant lymphoma, the others are alive. Of these, one patient has developed renal failure and received a renal transplant. The other patients have preserved a normal renal function and the majority have been healthy and working full time. Treatment rarely resulted in normokalaemia. The annual incidence of the syndrome has been estimated at 1.2 per million people.
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Affiliation(s)
- A Rudin
- Department of Medicine II, Sahlgrenska Hospital, University of Göteborg, Sweden
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Proesmans W, Massa G, Vanderschueren-Lodeweyckx M. Growth from birth to adulthood in a patient with the neonatal form of Bartter syndrome. Pediatr Nephrol 1988; 2:205-9. [PMID: 3153013 DOI: 10.1007/bf00862592] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Growth from birth to the age of 19 years was studied in a patient with the neonatal form of Bartter syndrome. The initial modes of therapy (extra fluid, potassium supplements and triamterene) resulted in satisfactory but not optimal growth. Treatment with spironolactone together with potassium led to impressive catch-up growth. When the patient reached the age of 9 years, indomethacin therapy was started, which resulted in a second growth acceleration and was also accompanied by a significant reduction of both polyuria and hypercalciuria. Puberty developed normally, menarche occurred at 12 years 4 months and a normal adult height of 162 cm was reached at the age of 14 years. Treatment with prostaglandin synthetase inhibitors seems to be the best therapy for children with the neonatal form of Bartter syndrome.
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Affiliation(s)
- W Proesmans
- Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
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Rezeptorstörungen in der Endokrinologie. Internist (Berl) 1988. [DOI: 10.1007/978-3-662-39609-4_67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Adam O, Goebel FD. [Secondary gout and pseudo-Bartter syndrome in females with laxative abuse]. KLINISCHE WOCHENSCHRIFT 1987; 65:833-9. [PMID: 3657045 DOI: 10.1007/bf01727480] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Four females (27-54 y), presenting with a history of long-term laxative abuse, were admitted to the Medizinische Poliklinik for evaluation of generalized weakness. Laboratory findings revealed signs of Bartter's syndrome, including hypokalemia, systemic alkalosis and normal blood pressure. Three of the four females showed impaired renal function and elevated serum uric acid levels, two of them suffered from recurrent gouty attacks. In our patients the incidence of hyperuricemia and impaired renal function, as a consequence of chronic hypokalemia, was much higher than known from patients with Bartter's syndrome. Hyperuricemia is related to some pathophysiological features of Pseudo-Bartter's syndrome, (e.g. systemic alkalosis, elevated angiotensin) and combined with additional factors (e.g. catabolism, reduced plasma volume) may lead to gouty attacks. Gallstones were found in two of the four females. Long term surreptitious laxative ingestion frequently is observed in females. Hypokalemia, induced by the laxatives, causes reduced intestinal motility and leads to augmented laxative intake. These patients are prone to develop Pseudo-Bartter's syndrome, causing eventually a hyperuricemia and gouty attacks.
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Affiliation(s)
- O Adam
- Medizinische Poliklinik der Universität München
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Seyberth HW, Königer SJ, Rascher W, Kühl PG, Schweer H. Role of prostaglandins in hyperprostaglandin E syndrome and in selected renal tubular disorders. Pediatr Nephrol 1987; 1:491-7. [PMID: 3153322 DOI: 10.1007/bf00849259] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Renal and systemic prostanoid activity was assessed in various renal tubular disorders, using mass spectrometric determination of urinary excretion rates of primary prostaglandins (PGE2, PGF2 alpha, PGI2, and TXA2) and their systemically produced index metabolites. Only PGE2 levels (normal range: 2.0-16.4 ng/h per 1.73 m2) are elevated in Bartter syndrome (median: 43.4, range: 6.7-166.3), nephrogenic diabetes insipidus (46.2, 12.1-1290), Fanconi syndrome (96.6, 19.3-135.5), and in a complex tubular disorder in premature infants (40.7, 22.3-132.1), for which the term hyperprostaglandin E syndrome has been introduced. In this disorder with a Bartter-syndrome-like tubulopathy, the systemic features of the disease such as fever, diarrhoea and osteopenia with hypercalciuria were associated with increased systemic PGE2 activity. In most patients the urinary excretion rate of the systemic index metabolite of PGE2 (PGE-M) was markedly elevated (1028, 285-4709; normal range: 104-664 ng/h per 1.73 m2). Hypercalciuria per se was associated neither with increased renal nor with systemic PGE2 hyperactivity. Most problems in infants with hyperprostaglandin E syndrome could be controlled by long-term indomethacin treatment in contrast to the moderate and partial effect of this treatment in patients with Fanconi syndrome. Thus increased PGE2 synthesis plays a major role in the pathogenesis of hyperprostaglandin E syndrome, while in Fanconi syndrome PGE2 hyperactivity in the kidney is a secondary event and only aggravates the water and electrolyte wastage.
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Affiliation(s)
- H W Seyberth
- Kinderklinik der Universität Heidelberg, Heidelberg, Federal Republic of Germany
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Kramer HJ, Kipnowski J, Düsing R. The role of renal prostaglandins in the regulation of renal sodium excretion. AGENTS AND ACTIONS. SUPPLEMENTS 1987; 22:61-72. [PMID: 3481214 DOI: 10.1007/978-3-0348-9299-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- H J Kramer
- Medizinische Universitäts-Poliklinik, Bonn, F.R.G
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Steiner RW, Omachi AS. A Bartter's-like syndrome from capreomycin, and a similar gentamicin tubulopathy. Am J Kidney Dis 1986; 7:245-9. [PMID: 2420173 DOI: 10.1016/s0272-6386(86)80012-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Marked renal potassium and magnesium wasting, alkalosis, and a progressive increase in plasma renin and eventual hyperaldosteronemia developed during a 15-month course of in-hospital capreomycin therapy that was necessary for drug-resistant pulmonary tuberculosis. A prominent feature of the present case was renal chloride wasting, a feature of the capreomycin syndrome that has previously received little attention. Similar potentially life-threatening metabolic abnormalities, which resemble those found in Bartter's syndrome, can occur during prolonged therapy with the antibiotic gentamicin. In the present case, electrolyte abnormalities were unaffected by three days of indomethacin therapy but were partially corrected by large doses of spironolactone. Capreomycin, viomycin (an antibiotic closely related to capreomycin), and gentamicin are highly basic polypeptide antibiotics that may induce strikingly similar and potentially fatal syndromes of renal tubular dysfunction that can feature multiple electrolyte abnormalities.
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Gordon RD. Syndrome of hypertension and hyperkalemia with normal glomerular filtration rate. Hypertension 1986; 8:93-102. [PMID: 3002982 DOI: 10.1161/01.hyp.8.2.93] [Citation(s) in RCA: 169] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
There are several important mechanisms by which renal prostaglandins modulate renal salt and water excretion. The role of endogenous renal prostaglandins in facilitating urinary sodium excretion and the individual nephron segments that are affected by renal prostaglandins are reviewed. The role of the administration of nonsteroidal anti-inflammatory agents on the kidney's ability to excrete salt and water both physiologically and clinically is summarized. The potential role for endogenous prostaglandins to antagonize the effect of antidiuretic hormone and to alter renal water excretion is also described. The clinical consequences of taking nonsteroidal anti-inflammatory drugs in terms of hyperkalemia, sodium retention with associated edema, and possible hyponatremia are all discussed. Although these clinical consequences are quite uncommon statistically, there are certain subsets of patients for whom additional concern is important.
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Seyberth HW, Rascher W, Schweer H, Kühl PG, Mehls O, Schärer K. Congenital hypokalemia with hypercalciuria in preterm infants: a hyperprostaglandinuric tubular syndrome different from Bartter syndrome. J Pediatr 1985; 107:694-701. [PMID: 3863906 DOI: 10.1016/s0022-3476(85)80395-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A congenital hypokalemic tubular disorder is described with many features resembling Bartter syndrome. Additional features include prenatal onset with polyhydramnios and premature labor; failure to thrive; episodes of fever, vomiting, diarrhea, and renal electrolyte and water wastage; hypercalciuria; nephrocalcinosis; and osteopenia. Unlike Bartter syndrome, there is no defect in tubular reabsorption of chloride. Urinary levels of prostaglandin E2 and 7 alpha-hydroxy-5,11-diketotetranorprosta-1,16-dioic acid are selectively elevated, indicating marked stimulation of renal and systemic PGE2 production. Chronic suppression of PGE2 activity by indomethacin corrects most of the abnormalities, and there is an immediate decompensation of the disease on indomethacin withdrawal. We conclude that these preterm infants have a distinct variety of hypokalemic tubular disorders rather than a variant of Bartter syndrome, because renal and systemic hyperprostaglandinism ranks high in the pathogenic chain of events, and the suppression of PGE2 hyperactivity is associated with significant improvement in the development (and probably in the prognosis) of the affected children.
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Rodriguez-Portales JA, Lopez-Moreno JM, Mahana D. Inhibition of the kallikrein-kinin system and vascular reactivity in Bartter's syndrome. Hypertension 1985; 7:1017-22. [PMID: 2416684 DOI: 10.1161/01.hyp.7.6.1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To study the significance of the increased activity of the kallikrein-kinin system described in patients with Bartter's syndrome, we investigated the pressor response to infused angiotensin II in four patients with the syndrome receiving no treatment and during the administration of aprotinin and of indomethacin. Five normal subjects served as controls. Aprotinin is a proteolytic enzyme that inhibits the formation of kinins by inhibiting plasma and glandular kallikrein. Indomethacin, a prostaglandin-synthesis inhibitor, can also inhibit the kallikrein-kinin system and normalizes vascular responsiveness to angiotensin II in Bartter's syndrome. All patients had increased urinary kallikrein and prostaglandin E2 concentrations. Aprotinin significantly decreased the dose of infused angiotensin II required to induce a 20 mm Hg increase in diastolic blood pressure, from 11 +/- 4 ng/kg/min to 7.0 +/- 2.0 ng/kg/min (mean +/- SD; p less than 0.05) in normal subjects and from 135 +/- 57 ng/kg/min to 70 +/- 26 ng/kg/min (p less than 0.05) in the patients with Bartter's syndrome, without significantly changing plasma renin activity, mean control blood pressure, or urinary prostaglandin E2 concentration. Indomethacin normalized the pressor response to angiotensin II in three patients who had been pretreated for 4 days (pressor dose, 10 ng/kg/min) but not in one patient who received a single oral dose of indomethacin 5 hours before the test. Our results suggest that inhibition of the kallikrein-kinin system alone accounts for approximately a 50% decrease in vascular resistance to the pressor effect of angiotensin II in Bartter's syndrome, while additional suppression of prostaglandins entirely normalizes the vascular response to angiotensin II.(ABSTRACT TRUNCATED AT 250 WORDS)
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Boer P, Koomans HA, Hené RJ, Geyskes GG, Van Shaik BA, Roos JC, Dorhout Mees EJ. Blood to interstitial fluid volume ratio in chronic hypokalaemic states. Eur J Clin Invest 1985; 15:276-80. [PMID: 3935459 DOI: 10.1111/j.1365-2362.1985.tb00184.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The distribution of extracellular fluid over the intra- and extravascular spaces was determined in hypokalaemic and normokalaemic patients. In six patients with Bartter's syndrome, four with pseudo-Bartter's syndrome, and twenty with essential hypertension (EH) chronically treated with chlorthalidone, serum potassium (serum K+) and extracellular fluid volume (ECFV) were decreased, while plasma volume (PV) and blood volume (BV) were normal (see Table 1 for means, standard deviations, and levels of significance). Consequently, the ratio of BV to interstitial fluid volume (IFV) was increased. In ten patients with EH on long-term combined enalapril chlorthalidone therapy, eight EH patients on long-term spironolactone treatment, and twenty-three EH patients treated by short-term sodium restriction, PV, BV, and ECFV were decreased, but serum K+ and BV/IFV were normal. In six patients with primary hyperaldosteronism (PHA) serum K+ was decreased, while PV, BV, and BV/IFV were elevated. Significant negative correlations between sK and BV/IFV were found in the Bartter patients (r = -0.88) and the pooled data of all patients (r = -0.50). These findings suggest an association between chronic hypokalaemia and a fluid shift from the extra- into the intravascular space. The hypothesis that this phenomenon is due to a decreased venous resistance as a consequence of chronic hypokalaemia is discussed.
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Blethen SL, Van Wyk JJ, Lorentz WB, Jennette JC. Reversal of Bartter's syndrome by renal transplantation in a child with focal, segmental glomerular sclerosis. Am J Med Sci 1985; 289:31-6. [PMID: 3881952 DOI: 10.1097/00000441-198501000-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A four-year-old girl with growth failure and clinical and laboratory evidence of Bartter's syndrome responded to indomethacin treatment with decreased urinary prostaglandin excretion, symptomatic and chemical improvement, and accelerated growth. Large doses of aspirin produced a comparable decrease in prostaglandin excretion but no improvement in any other metabolic abnormality thus suggesting that abnormalities in prostaglandins were the result rather than the cause of the electrolyte abnormalities. Progressive renal insufficiency while on indomethacin prompted a renal biopsy, which revealed morphological changes of focal, segmental glomerular sclerosis. Subsequently, the child underwent renal transplantation with complete resolution of symptoms and abnormal metabolic findings. This observation suggests that extrarenal factors were not responsible for the development of Bartter's syndrome in this child.
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Hornych A, Krief C, Aumont J. Urinary prostaglandins in Bartter's and pseudo-Bartter's syndrome. UREMIA INVESTIGATION 1985; 9:203-10. [PMID: 3870249 DOI: 10.3109/08860228509088212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Renal secretion of prostaglandins (PG) in Bartter's syndrome and in different forms of hypokalemic normotensive syndromes (pseudo-Bartter's syndrome) was measured to determine if it is possible to use the measurement of urinary prostaglandins for the discrimination of different etiologies. Prostaglandins E2, F2 alpha, 6-keto-PGF1 alpha and thromboxane B2 (TxB2) were measured after extraction and chromatography by radioimmunoassay in 19 patients and in 26 control healthy subjects. Bartter's syndrome may be characterized as primary renal hyperprostaglandinism with high urinary PGE2 excretion. It can be dissociated from pseudo-Bartter's syndrome because the urinary PGE2 excretion is always in the normal range in the pseudosyndrome. Abuse of loop diuretics may have effects that mimic Bartter's syndrome since these diuretics stimulate urinary prostaglandin excretion. Therefore, loop diuretics should always be excluded prior to the diagnosis of Bartter's syndrome.
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Padfield PL, Grekin RJ, Nicholls MG. Clinical syndromes associated with disorders of renal tubular chloride transport: excess and deficiency of a circulating factor? Med Hypotheses 1984; 14:387-400. [PMID: 6387403 DOI: 10.1016/0306-9877(84)90145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two contrasting patients are described, one with pseudo-Bartter's syndrome induced by frusemide abuse and the other a case of hyporeninaemic hypoaldosteronism. The clinical and biochemical features of these two conditions are the opposite of each other and, in the first patient, the effects of frusemide were antagonised by treatment with indomethacin while in the second frusemide itself corrected the syndrome. The decreased pressor sensitivity to infused angiotensin II seen in the patient with pseudo-Bartter's syndrome was corrected with indomethacin and the enhanced pressor sensitivity seen in hyporeninaemic hypoaldosteronism was reversed with frusemide. Frusemide, an agent which blocks chloride transport at the ascending limb of Henle's loop, was respectively thus the cause and the cure of these conditions. On the basis of this the suggestion is made that Bartter's syndrome and hyporeninaemic hypoaldosteronism represent respectively an excess and a deficiency of a circulating factor similar to frusemide capable of blocking renal tubular chloride transport.
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Ooi TC, Poznanski WJ, Ooi DS. The value of urinary chloride measurement in distinguishing surreptitious vomiting from Bartter's syndrome. Clin Biochem 1983; 16:263-5. [PMID: 6616813 DOI: 10.1016/s0009-9120(83)90182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Urinary chloride measurement is a simple and common procedure but its value in clinical practice is not extensive. This case report highlights a practical and important use of this test. A patient presented with most of the clinical and metabolic derangements of Bartter's syndrome but was found to have extremely low or absent urinary chloride excretion. Her ability to excrete chloride was, however, intact during a chloride load test. The finding of low urinary chloride excretion did not support the diagnosis of Bartter's syndrome and suggested an extrarenal loss of chloride. This was confirmed when she eventually admitted to surreptitious vomiting.
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Müllner G, Gähwiler T, Lüthy C, Oetliker O, Dillon MJ, Rosa FC. Comparison of prostaglandin production of skin fibroblasts grown from patients with Bartter's syndrome and from age and sex matched controls. PROSTAGLANDINS, LEUKOTRIENES, AND MEDICINE 1983; 11:83-93. [PMID: 6410415 DOI: 10.1016/0262-1746(83)90112-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Basal and bradykinin stimulated release of prostaglandins (6-oxo-PGF1 alpha, PGF2 alpha, PGE2) and of arachidonic acid (C20:4) from skin fibroblast cultures of two patients with Bartter's Syndrome were compared with age and sex matched controls. PG-formation from 14C-C20:4 was studied, and for PGE2 a radioimmunoassay was also employed. The data show that in basal release, Bartter's Syndrome fibroblasts produce significantly less PGE2 than controls. Stimulated release of 6-oxo-PGF1 alpha was higher, that of PGE2 lower and that of C2O:4 higher in Bartter's Syndrome than in controls, all differences being significant. Despite equal culturing conditions the estimated intracellular potassium was higher in the patients fibroblasts than in controls. In skin fibroblasts from patients with Bartter's Syndrome stimulated prostaglandin production from C2O:4 is mostly depressed, with the exeption of prostacyclin which is enhanced. The permeability of cell membranes for potassium might play a pathogenetic role.
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Düsing R, Bartter FC, Gill JR, Krück F, Kramer HJ. [Bartter's syndrome]. KLINISCHE WOCHENSCHRIFT 1983; 61:311-9. [PMID: 6345917 DOI: 10.1007/bf01485021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fujita T, Ando K, Sato Y, Yamashita K, Nomura M, Fukui T. Independent roles of prostaglandins and the renin-angiotensin system in abnormal vascular reactivity in Bartter's syndrome. Am J Med 1982; 73:71-6. [PMID: 7046439 DOI: 10.1016/0002-9343(82)90928-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To clarify the independent roles of prostaglandins and the renin-angiotensin system in the pressor resistance to angiotensin II in Bartter's syndrome, the pressor responsiveness to exogenous angiotensin II was investigated in three patients with the syndrome during the administration of indomethacin synthesis, and captopril is an angiotensin-converting enzyme inhibitor. All the patients showed high plasma renin activity, increased urinary excretion of prostaglandin E, and pressor resistance of angiotensin II. An analogue of angiotensin II that had weak agonistic properties induced a marked fall in blood pressure. Pretreatment with indomethacin (150 mg/day) decreased baseline plasma renin activity and reversed the hypotensive effect of the analogue of angiotensin II. Apparently, our data support the concept that pressor resistance ultimately results from the increase in the concentration of endogenous angiotensin II. However, the augmentation of indomethacin was significantly (p less than 0.01) greater in magnitude than the response obtained with captopril, although the concentration of plasma angiotensin II prior to each infusion of angiotensin II was the same. This observation could be explained by the finding that indomethacin suppressed both systems, but captopril inhibited only the renin-angiotensin system. Evidence presented herein suggests that the abnormalities in the vascular reactivity to angiotensin II may result from, not only the decreased number of receptor sites as a results of the increased concentration of endogenous angiotensin II, but also from the alteration of the end-organ sensitivity to angiotensin II via overproduction of prostaglandins.
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Abstract
A patient with profound hypokalemia satisfied the criteria for Bartter's syndrome, including hyperreninemia, aldosteronism, normal blood pressure, and hyperplasia of the juxtaglomerular apparatus. Two screening tests of urine and one of plasma for diuretic agents gave negative results. A third urinary sample gave negative results for thiazide but positive for furosemide; the fourth and fifth samples gave negative results for furosemide but positive for thiazide. Urinary prostaglandin excretion was normal. We conclude that this apparent case of Bartter's syndrome was caused by long term surreptitious diuretic ingestion and suggest this may occur more frequently than is generally appreciated.
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Tsunoda S, Tsushima T, Nishioka T, Ohno N, Fukunaga T, Takano K, Yumura W, Shizume K, Branch RA. Familial Bartter's syndrome and the effect of indomethacin in one family member. J Urol 1982; 127:1000-5. [PMID: 7086975 DOI: 10.1016/s0022-5347(17)54174-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A Japanese family in which a father, daughter and son had hypokalemia and hyperreninemia was investigated. Both father and daughter had reduced vascular sensitivity to angiotensin II; in addition, the daughter had juxtaglomerular cell hyperplasia and dwarf glomeruli. These features are consistent with Bartter's syndrome occurring in 2 successive generations in 1 family. The 12-year-old girl had growth retardation in spite of normal growth hormone secretion. No chromosomal abnormalities were found. Indomethacin administration to this patient in doses sufficient to reduce urinary prostaglandin excretion resulted in a marked improvement of polydipsia and polyuria, and an increase in serum sodium, potassium and chloride concentrations. Even though plasma aldosterone concentrations were reduced to within the normal range, serum potassium concentrations remained low, and plasma renin activity (PRA) remained elevated. Thus it is not likely that hypokalemia is induced only by aldosteronism. These results suggest that prostaglandins are the major determinant of polydipsia, polyuria and high plasma aldosterone levels and contribute to the hypokalemia observed in this patient. However, the failure of complete correction of the hypokalemia and the persistence of the raised PRA with a significant reduction of the prostaglandins suggest the possibility that additional factors are involved in the pathogenesis of Bartter's syndrome.
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Abstract
Renal prostaglandins are gaining increasing recognition as important modulators of hemodynamics and excretory function in the mammalian kidney. Synthesis of these unsaturated fatty acids from arachidonate precursors is closely regulated by intrarenal factors, and circulating angiotensin II, catecholamines, arginine vasopressin and bradykinin. Endogenous prostaglandins exert little influence on renal blood flow and glomerular filtration rate in the basal state, but inhibition of arachidonate metabolism when renal perfusion is impaired causes marked alterations in these parameters. Renal salt and water excretion is modified by the effects of prostaglandins on glomerular filtration rate, proximal tubule fluid reabsorption, medullary solute gradients, and the intrinsic water and ion reabsorptive properties of distal nephron segments. Prostaglandins also mediate renin release under basal conditions and in response to intravascular volume depletion. Abnormalities of renal prostaglandins are evident in various clinical disorders of renal function including hypertension, ureteral obstruction, Bartter syndrome, hypokalemic nephropathy and drug-induced disorders of water metabolism. Appropriate clinical use of nonsteroidal anti-inflammatory agents requires consideration of the potential renal consequences of inhibiting prostaglandin biosynthesis.
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Rodriguez JA, Delea CS, Bartter FC, Siragy H. The effect of vasopressin in water-loaded hypokalemic patients is prostaglandin-independent. PROSTAGLANDINS AND MEDICINE 1981; 7:465-72. [PMID: 7323209 DOI: 10.1016/0161-4630(81)90034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Potassium-depleted subjects regularly excrete dilute urine with a high free-water clearance which cannot be suppressed either by solute loading or by water deprivation. In man, as in the dog and rat, potassium depletion impairs the ability of the kidney to achieve maximal urinary solute concentration and vasopressin is unsuccessful in overcoming this defect. In man and in the dog, potassium depletion induces a rise in urinary prostaglandin E2, an effect which can be reversed with indomethacin, a cyclo-oxygenase inhibitor. To evaluate the role of prostaglandins on the renal action of vasopressin in hypokalemia, six subjects with hypokalemia of various etiologies were studied in a control, drug-free condition and again after 3 to 6 days of indomethacin (100 mg/day). Renal clearance studies to measure the maximal free-water excretion in response to an intravenous water load (10 ml/min) and to a superimposed infusion of arginine vasopressin (40 mU/hr) were performed. The results in six patients are as follows: maximal free-water clearance (control) 8.03 +/- 0.8 ml/min (mean +/- S.E.), with the addition of vasopressin, .14 +/- 0.8; after 3 to 6 days of indomethacin, 8.55 +/- 1.33; with vasopressin 0.91 +/- 1.23 ml/min. There was no statistically significant difference between the maximal free water clearance with or without indomethacin. Vasopressin exerted an equally great response in both conditions and prostaglandins did not appear to play a role in free-water formation.
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Adamick R, Gold ME, Hayes S, Coleman R, McCreary JT, Sabatini S, Arruda JA, Kurtzman NA. Factors influencing vascular hyporesponsiveness to angiotensin II. Circ Res 1981; 49:932-9. [PMID: 7273363 DOI: 10.1161/01.res.49.4.932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Bartter's syndrome is characterized, in part, by hyporesponsiveness to the pressor effect of exogenous angiotensin II (AII). This has been attributed to volume contraction, hypokalemia, and/or increased prostaglandin (PG) levels. In order to investigate factors responsible for a diminished response to the pressor effect of AII, rats were made hypokalemic or volume contracted and hypokalemic (VCHK) by dietary restriction. AII sensitivity was examined by determining the dose of AII required to raise the mean arterial pressure 20 mm Hg. When compared with control rats. VCHK and hypokalemic rats were significantly less sensitive to AII. VCHK rats were significantly less sensitive to AII than hypokalemic rats. Both experimental groups were similarly hypokalemic, but plasma renin activity (PRA) of VCHK only was greater than control values. In VCHK rats, acute K+ restoration partially corrected AII hyporesponsiveness, although plasma K+ increased to normal. In VCHK rats, acute volume expansion with normal saline similarly achieved only partial correction of AII hyporesponsiveness although PRA values fell to the control range. Simultaneous K+ restoration and volume expansion to VCHK rats successfully restored AII sensitivity to the control range. Dietary sodium, chloride, and potassium restriction did not increase urinary excretion to PGE2. Indomethacin (5 mg/kg, iv) given acutely to VCHK rats did not significantly after baseline hyporesponsiveness to AII. Norepinephrine vascular sensitivity was not affected by either volume contraction or hypokalemia. These data demonstrate that volume contraction and hypokalemia individually depress exogenous AII sensitivity in the rat and do so by separate and additive mechanisms. Furthermore, these mechanisms appear to be independent of PG.
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Rolland PH, Rolland AM, Benkoel L, Toga M. Prostaglandins and steroidogenesis in isolated bovine adrenal cells. Effects of ACTH, prostaglandin-synthesis inhibitors, prostaglandins and prostaglandin analogs. Mol Cell Endocrinol 1981; 22:179-93. [PMID: 6263734 DOI: 10.1016/0303-7207(81)90090-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In bovine adrenal cortex cells, dispersed without preferential loss of cells, we investigated (1) whether endogenous prostaglandins (PGs) are involved in ACTH-induced adrenal steroidogenesis, and (2) the steroidogenic effects of PGs and PG analogs. Free cells produced considerable amounts of PGE2, whereas only minute quantities of PGF2 alpha and PGA1 were synthesized. PGE2 synthesis, however, was not significantly increased when ACTH elicited a steroidogenic response in free cells. High concentrations of PG-synthesis inhibitors such as indomethacin affected both PG synthesis and steroidogenesis, whereas intermediate concentrations (10(-6) M) inhibited production of both PGE2 and aldosterone even after cAMP and cortisol response to ACTH had returned to normal values. It is concluded that endogenous PGE2 is not a link in the acute mechanism of action of trophic hormones in which cAMP is involved. Of the prostanoid structures, PGs of the E series were the most potent stimulating agents of cortisol production, although less active than ACTH. On the other hand, PGA1 induced an ACTH-like aldosterone synthesis. PGE2 was less active, and other prostanoid structures were without effect on aldosterone production. It is suggested that in pathological circumstances, PGA1 regulates aldosterone production and PGE2 increases both aldosterone and cortisol production.
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Bartter FC. Bartter's syndrome: a disorder of vascular reactivity. Arthur C. Corcoran Memorial Lecture. Hypertension 1981; 3:I69-73. [PMID: 7262981 DOI: 10.1161/01.hyp.3.3_pt_2.i69] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Lechi A, Mantero F, Opocher G, Armanini D, Lechi C, Covi G. Effect of indomethacin on urinary kallikrein excretion in Bartter's syndrome of the adult. J Endocrinol Invest 1981; 4:17-20. [PMID: 7016967 DOI: 10.1007/bf03349408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An elevated urinary kallikrein excretion was found in 3 out of 4 adult patients with Bartter's syndrome. After prostaglandin synthesis inhibition by indomethacin, serum potassium levels rose, plasma renin activity and urinary aldosterone excretion decreased. Urinary kallikrein excretion was reduced to within normal range in all patients. The fall of urinary kallikrein excretion after indomethacin may be partly due to plasma potassium and aldosterone variations, but more likely it is dependent on the reduced prostaglandin synthesis. These results support the hypothesis that renal prostaglandins activate renal kallikrein-kinin system, hence inducing an increase of renal blood flow, diuresis and natriuresis.
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Franco-Saenz R, Suzuki S, Tan SY. Prostaglandins and renin production: a review. PROSTAGLANDINS 1980; 20:1131-43. [PMID: 7010449 DOI: 10.1016/0090-6980(80)90065-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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