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Shaukat H, Nadeem S, Abdullah F, Khan MMM, Rizvi SW. Gitelman Syndrome and Hypertension: A Case Report. Cureus 2023; 15:e44590. [PMID: 37795074 PMCID: PMC10545885 DOI: 10.7759/cureus.44590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/06/2023] Open
Abstract
In a patient with persistent hypokalemia, it is important to consider Gitelman syndrome, a rare, salt-wasting tubulopathy inherited in an autosomal recessive pattern. Gitelman syndrome leads to electrolyte abnormalities like hypokalemia, hypomagnesemia, and metabolic alkalosis. Typical clinical features include muscle cramps, fatigue, polydipsia, and salt cravings. Our case involves a female patient in her early 40s who visited the endocrinology clinic with symptoms of polyuria, constipation, muscle weakness, and fatigue. Electrolyte abnormalities included hypokalemia, hypomagnesemia, hypochloremia, and hyperreninemia. Initial tests, such as renal function tests, renal ultrasound, and CT scan, yielded normal results. Differential diagnosis of Gitelman syndrome and Bartter syndrome was considered due to the mutual electrolyte abnormalities of hypokalemia and metabolic alkalosis. Bartter syndrome was ruled out in our patient due to the presence of hypomagnesemia, which indicates a different defective receptor. Ultimately, genetic testing would be necessary to confirm the diagnosis of Gitelman syndrome considering the characteristic electrolyte disturbances and classic clinical presentation of fatigue, weakness, and salt craving.
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Affiliation(s)
- Hiba Shaukat
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Fnu Abdullah
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | - Syed W Rizvi
- Medicine, University of Medicine and Dentistry of New Jersey, Newark, USA
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2
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Bi Y, Kuang MY, Li ML. Novel heterozygous mutations of SLC12A3 gene in a Chinese pedigree with Gitelman syndrome: A care-compliant case report. Medicine (Baltimore) 2023; 102:e34967. [PMID: 37657006 PMCID: PMC10476831 DOI: 10.1097/md.0000000000034967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE The diagnosis of Gentleman syndrome (GS) is usually delayed because the clinical symptoms are easily mistaken. PATIENT CONCERNS A 19-year-old male patient was referred to endocrinology due to intermittent twitch of extremities for approximately 7 years. DIAGNOSES The diagnosis of GS was made based on the laboratory and gene detection results. We identified 2 new variants in the SLC12A3 gene [c.857 A > C (exon7) and c.2089_2095del (exon17)] in his Asian family. INTERVENTIONS The patient received the treatment of potassium chloride sustained release tablets, potassium magnesium aspartate and spironolactone. After given potassium supplement through enema, his serum potassium level was corrected to normal. OUTCOMES The electrolyte imbalance including hypokalemia and hypomagnesemia were improved with a remission of the clinical manifestations. But the patient's condition still could not remain stable for his irregular oral potassium supplementation during the follow-up of nearly 3 months. LESSONS Our finding broadens the variant spectrum of SLC12A3 and contributes to a more quickly genetic counseling. As a result, when a patient presents with persistent, unspecified, and inadequately treated hypokalemia, tests for GS should indeed be considered. For suspected cases of GS, genetic testing should always be considered in the diagnosis.
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Affiliation(s)
- Ye Bi
- Department of Geriatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ming-Yang Kuang
- Department of Geriatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ming-Long Li
- Department of Geriatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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3
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Idries IY, Azhar M, Yadav R, Nevolina A, Ullah A, Sur A, Zadoretska I, Gunsburg M. Heart's Dangerous Symphony: Torsade De Pointes Unleashed by Gitelman Syndrome-Induced Hypomagnesemia. Cureus 2023; 15:e44464. [PMID: 37791211 PMCID: PMC10544222 DOI: 10.7759/cureus.44464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Gitelman syndrome (GS) is a rare autosomal recessive salt-losing renal tubular disorder associated with a mutation of SLC12A3 or CLCNKB genes which encodes the thiazide-sensitive sodium-chloride co-transporter (NCCT) in the distal renal tubule. It is inherited as an autosomal recessive disorder. Hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, and renin-angiotensin-aldosterone system (RAAS) activation are characteristics of GS. GS is often misdiagnosed or underdiagnosed owing to its low incidence and lack of awareness. Its prevalence is estimated to be around 1-10 per 40,000 people. We report a case of cardiac arrest secondary to torsade de pointes (TdP) because of GS-induced hypomagnesemia. Our case highlights the importance of clinicians being aware of the potential electrolyte abnormalities and complications associated with GS, as it can lead to catastrophic consequences if not identified and corrected earlier.
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Affiliation(s)
- Iyad Y Idries
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Muhammad Azhar
- Nephrology, Brookdale University Hospital Medical Center, New York, USA
| | - Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, New York, USA
| | - Anna Nevolina
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Abid Ullah
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Avtar Sur
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Iryna Zadoretska
- Hematology and Oncology, Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine, lviv, UKR
| | - Moshe Gunsburg
- Electrophysiology, Brookdale University Hospital Medical Center, New York, USA
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Janchevska A, Tasic V, Jordanova O, Gucev Z, Jenkins L, Jovanovska N, Plaseska-Karanfilska D, Ashton E, Bockenhauer D. Two Brothers from Macedonia with Gitelman Syndrome. Balkan J Med Genet 2023; 26:69-74. [PMID: 37576796 PMCID: PMC10413880 DOI: 10.2478/bjmg-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Gitelman syndrome (GS) is a rare renal tubulopathy with an autosomal recessive mode of inheritance, caused by biallelic pathogenic variants in the SLC12A3 gene. The clinical features may overlap with other disorders, such as Bartter syndrome type 3, HNF1B nephropathy or even mitochondrial disease, but can be distinguished by molecular genetic analysis. Here we report on two preschool brothers, who presented with a several months' history of episodes of carpopedal spasms and muscle aches. The biochemical analyses revealed hypokalemia and hypomagnesemia without metabolic alkalosis. A 24-h urine sample demonstrated hypocalciuria. The molecular analyses showed that both patients were heterozygous for 3 (likely) pathogenic variants in SLC12A3: c.1805_1806del; p. (Tyr602Cysfs*31), c.2660+1G>A and c.2944 A>T; p. (Ile982Phe). Analysis of the parents showed that the mother was heterozygous for the c.2944 A>T p.(Ile982Phe) variant, and the father carried the other 2 variants (c.1805_1806del and c.2660+1G>A). Herein we present two children in a family from N. Macedonia with clinical manifestations and electrolyte imbalances suggestive of GS. The results of the tubulopathy next generation sequencing (NGS) panel confirmed the diagnosis. The boys are treated with a high salt diet and oral potassium and magnesium supplements.
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Affiliation(s)
- A Janchevska
- University Children’s hospital, Skopje, Rep. of N. Macedonia
| | - V Tasic
- University Children’s hospital, Skopje, Rep. of N. Macedonia
| | - O Jordanova
- University Children’s hospital, Skopje, Rep. of N. Macedonia
| | - Z Gucev
- University Children’s hospital, Skopje, Rep. of N. Macedonia
| | - L Jenkins
- North East Thames Regional Genetic Laboratory, Great Ormond Street Hospital for children, London, UK
| | - N Jovanovska
- Research Center for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, Skopje, Rep. of N. Macedonia
| | - D Plaseska-Karanfilska
- Research Center for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, Skopje, Rep. of N. Macedonia
| | - E Ashton
- North East Thames Regional Genetic Laboratory, Great Ormond Street Hospital for children, London, UK
| | - D Bockenhauer
- North East Thames Regional Genetic Laboratory, Great Ormond Street Hospital for children, London, UK
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Cocco N, Leibundgut G, Pelliccia F, Cammalleri V, Nusca A, Mangiacapra F, Cocco G, Fanale V, Ussia GP, Grigioni F. Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned? Int J Mol Sci 2023; 24:10405. [PMID: 37373551 DOI: 10.3390/ijms241210405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
SARS-CoV-2 vaccination offered the opportunity to emerge from the pandemic and, thereby, worldwide health, social, and economic disasters. However, in addition to efficacy, safety is an important issue for any vaccine. The mRNA-based vaccine platform is considered to be safe, but side effects are being reported more frequently as more and more people around the world become treated. Myopericarditis is the major, but not the only cardiovascular complication of this vaccine; hence it is important not to underestimate other side effects. We report a case series of patients affected by cardiac arrhythmias post-mRNA vaccine from our clinical practice and the literature. Reviewing the official vigilance database, we found that heart rhythm disorders after COVID vaccination are not uncommon and deserve more clinical and scientific attention. Since the COVID vaccine is the only vaccination related to this side effect, questions arose about whether these vaccines could affect heart conduction. Although the risk-benefit ratio is clearly in favor of vaccination, heart rhythm disorders are not a negligible issue, and there are red flags in the literature about the risk of post-vaccination malignant arrhythmias in some predisposed patients. In light of these findings, we reviewed the potential molecular pathways for the COVID vaccine to impact cardiac electrophysiology and cause heart rhythm disorders.
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Affiliation(s)
- Nino Cocco
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gregor Leibundgut
- University Heart Center, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland
| | - Francesco Pelliccia
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00186 Rome, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Annunziata Nusca
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Fabio Mangiacapra
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, 65122 Chieti, Italy
| | - Valerio Fanale
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
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Zieg J, Tavačová T, Balaščáková M, Peldová P, Fencl F, Kubuš P. Sudden cardiac arrest in a child with Gitelman syndrome: a case report and literature review. Front Pediatr 2023; 11:1188098. [PMID: 37351317 PMCID: PMC10282639 DOI: 10.3389/fped.2023.1188098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Salt-losing tubulopathies are well-recognised diseases predisposing to metabolic disturbances in affected patients. One of the most severe complications can be life-threatening arrhythmias causing sudden cardiac arrest. We present here the first case of a pediatric patient with Gitelman syndrome associated sudden cardiac arrest without precipitating event. A 10-year-old boy collapsed due to ventricular fibrillation in the Prague tram. Lay cardiopulmonary resuscitation was initiated and external defibrillation restored sinus rhythm within minutes. Initial laboratory examination revealed severe hypokalemia requiring large amounts of electrolyte supplementation. Genetic testing focused to tubulopathies was performed and the diagnosis of Gitelman syndrome was made following the identification of two pathogenic variants in SLC12A3 gene (c.2633 + 1G>A and c.2221G>A). Implantable cardioverter-defibrillator was implanted to prevent sudden cardiac death. The patient was in a good clinical condition with satisfactory electrolyte serum levels at the last follow-up. Causes of electrolyte abnormalities in children should be identified early to prevent the development of rare but potentially fatal complications.
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Affiliation(s)
- Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Terezia Tavačová
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Miroslava Balaščáková
- Department of Biology and Medical Genetics, University Hospital Motol, Second Medical Faculty, Charles University, Prague, Czechia
| | - Petra Peldová
- Department of Biology and Medical Genetics, University Hospital Motol, Second Medical Faculty, Charles University, Prague, Czechia
| | - Filip Fencl
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
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Muacevic A, Adler JR, Roche M, Ngassa M. Cardiac Arrest as the First Presentation of Gitelman Syndrome. Cureus 2023; 15:e33565. [PMID: 36779094 PMCID: PMC9908823 DOI: 10.7759/cureus.33565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Gitelman syndrome is a salt-wasting tubulopathy characterized by profound hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Cardiac arrest is a relatively rare manifestation of Gitelman syndrome. Here we present a case of Gitelman syndrome in a patient with recurrent cardiac arrest. A 43-year-old female was admitted for out-of-hospital cardiac arrest secondary to ventricular fibrillation. Initial workup revealed severe hypokalemia, hypomagnesemia, metabolic alkalosis, and prolonged QTc. The workup revealed a picture of salt-wasting tubulopathy with hypokalemia, hypomagnesemia, and hypocalciuria. Potassium was repleted aggressively, and the patient received potassium-sparing agents resulting in the stabilization of potassium levels. Before discharge, an implantable cardioverter defibrillator (ICD) was placed for secondary prevention of cardiac arrest. The patient remained symptom-free, and electrolytes remained stable. This case highlights the diagnostic challenges of Gitelman syndrome and the importance of accurate diagnosis in improving patient outcomes.
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Cao Y, Hu D, Yun P, Huang X, Chen Y, Li F. Gitelman syndrome diagnosed in the first trimester of pregnancy: a case report and literature review. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Gitelman syndrome is a rare salt-losing tubulopathy caused by inactivating mutations in the SLC12A3 gene, which is expressed in the distal convoluted tubule and accounts for 5–10% of renal sodium reabsorption. Atypical symptoms and insidious conditions generally delay diagnosis until childhood or even adulthood. Here, we report the case of a 22-year-old Chinese woman who was admitted to our endocrinology department for severe hypokalemia during pregnancy.
Case presentation
The patient had no specific symptoms but exhibited hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, hyperreninemia, hyperaldosteronism, and normal blood pressure. Together, these symptoms indicated the clinical diagnosis of Gitelman syndrome, which was confirmed by genetic analysis. Many drugs have limited safety data during early pregnancy, and optimum potassium and magnesium levels are necessary for a successful pregnancy.
Conclusions
Diagnosis and management of Gitelman syndrome are crucial during pregnancy to ensure the safety of the mother and fetus, especially during the first trimester.
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Affiliation(s)
- Yang Cao
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Dan Hu
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Peng Yun
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Xinwei Huang
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Yan Chen
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Fangping Li
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
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Patni N, Fatima M, Lamis A, Siddiqui SW, Ashok T, Muhammad A. Magnesium and Hypertension: Decoding Novel Anti-hypertensives. Cureus 2022; 14:e25839. [PMID: 35836446 PMCID: PMC9273175 DOI: 10.7759/cureus.25839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
Abstract
Hypertension (HTN) is a complex multifactorial disease that is one of the most prevalent disorders in our modern world. It can lead to fatal complications like coronary artery disease (CAD) and congestive heart failure (CHF) in high-risk individuals. The silent nature of HTN also contributes to its immense caseload and, today, with a number of combinations and various antihypertensive agents, patient compliance is becoming increasingly difficult. This article has reviewed the role and mechanisms of magnesium (Mg) in reducing HTN in the human body so as to provide more information that may help include it as a mainstream antihypertensive regimen. This review has also shed light on the cardioprotective nature of Mg against pathologies like CHF with special mention to patient groups who are at high risk for low Mg levels. Many studies included in this article solidify the former link, but some also provide contradicting data.
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Wu CY, Tsai MH, Chen CC, Kao CH. Early diagnosis of Gitelman syndrome in a young child: A case report. World J Clin Cases 2022; 10:2844-2850. [PMID: 35434103 PMCID: PMC8968817 DOI: 10.12998/wjcc.v10.i9.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/11/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterized by renal wasting hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. It is usually caused by mutations in the gene SLC12A3, which encodes the thiazide-sensitive Na-Cl cotransporter. GS is not usually diagnosed until late childhood or adulthood.
CASE SUMMARY Here, we report the case of a one-year-old girl who was brought to the emergency department due to persistent vomiting for two days. On admission to our hospital, generalized weakness was observed, and laboratory investigations revealed severe hypokalemia (1.9 mmol/L). However, persistent hypokalemia was observed during outpatient follow-up. Suspicion of the GS phenotype was assessed via the patient’s clinical presentation, family history, and biochemical analysis of blood and urine. Further genetic analysis was performed for her and her family by exon-wide sequencing analysis of the gene SLC12A3. The genetic diagnosis of GS was established in the Taiwanese family with three affected individuals, two of whom were children (7 years/17 years) without obvious symptoms, with the youngest being only one year old (patient in our case).
CONCLUSION We successfully demonstrated the early diagnosis of GS using family genetic analysis. Any instances of hypokalemia should not be neglected, as early detection of GS with suitable treatment can prevent patients from potentially life-threatening complications.
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Affiliation(s)
- Chun-Yen Wu
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Ming-Hsein Tsai
- Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Chia-Chun Chen
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chuan-Hong Kao
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
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Kamejima S, Yamamoto I, Tajiri A, Tanno Y, Ohkido I, Yokoo T. Long-term Clinical Course after Living Kidney Donation by a Patient with Gitelman Syndrome Harboring a Compound Heterozygous Mutation of the SLC12A3 Gene. Intern Med 2021; 60:1567-1572. [PMID: 33328404 PMCID: PMC8188029 DOI: 10.2169/internalmedicine.5977-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The eligibility for kidney donation and long-term post-donation renal prognosis of patients with Gitelman syndrome (GS) are unknown. We herein report a 44-year-old woman with GS who donated her kidney for transplant. A gene sequence analysis revealed compound heterozygous mutations of T180K and L858H in the SLC12A3 gene. Since transplantation, the renal function and serum potassium and magnesium levels of the donor and recipient have remained stable for seven years with careful monitoring and supplementation. Patients with asymptomatic GS who have no complications can be considered eligible to donate their kidney for transplant with proper monitoring after transplantation.
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Affiliation(s)
- Sahoko Kamejima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Akiko Tajiri
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
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Micaglio E, Locati ET, Monasky MM, Romani F, Heilbron F, Pappone C. Role of Pharmacogenetics in Adverse Drug Reactions: An Update towards Personalized Medicine. Front Pharmacol 2021; 12:651720. [PMID: 33995067 PMCID: PMC8120428 DOI: 10.3389/fphar.2021.651720] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Adverse drug reactions (ADRs) are an important and frequent cause of morbidity and mortality. ADR can be related to a variety of drugs, including anticonvulsants, anaesthetics, antibiotics, antiretroviral, anticancer, and antiarrhythmics, and can involve every organ or apparatus. The causes of ADRs are still poorly understood due to their clinical heterogeneity and complexity. In this scenario, genetic predisposition toward ADRs is an emerging issue, not only in anticancer chemotherapy, but also in many other fields of medicine, including hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency, aplastic anemia, porphyria, malignant hyperthermia, epidermal tissue necrosis (Lyell's Syndrome and Stevens-Johnson Syndrome), epilepsy, thyroid diseases, diabetes, Long QT and Brugada Syndromes. The role of genetic mutations in the ADRs pathogenesis has been shown either for dose-dependent or for dose-independent reactions. In this review, we present an update of the genetic background of ADRs, with phenotypic manifestations involving blood, muscles, heart, thyroid, liver, and skin disorders. This review aims to illustrate the growing usefulness of genetics both to prevent ADRs and to optimize the safe therapeutic use of many common drugs. In this prospective, ADRs could become an untoward "stress test," leading to new diagnosis of genetic-determined diseases. Thus, the wider use of pharmacogenetic testing in the work-up of ADRs will lead to new clinical diagnosis of previously unsuspected diseases and to improved safety and efficacy of therapies. Improving the genotype-phenotype correlation through new lab techniques and implementation of artificial intelligence in the future may lead to personalized medicine, able to predict ADR and consequently to choose the appropriate compound and dosage for each patient.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Romani
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
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13
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Yang M, Dong Y, Tian J, Yan L, Chen Y, Qiu H, Liu W, Hu Y. A novel compound heterozygous mutation of SLC12A3 gene in a pedigree with Gitelman syndrome and literature review. Genes Genomics 2020; 42:1035-1040. [PMID: 32712837 DOI: 10.1007/s13258-020-00960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gitelman syndrome (GS) is a tubulopathy characterized by hypokalemia, hypomagnesemia, hypocalciuria and metabolic alkalosis, which is caused by mutations in SLC12A3 gene. OBJECTIVE The objective of this study was to investigate the mutation of SLC12A3 gene in a pedigree with GS and analyzed the clinical manifestations. METHODS Next-generation sequencing and Sanger sequencing were performed to explore the mutations of SLC12A3 gene in a GS pedigree that included a 59-year-old male GS patient and a total of 11 family members within three generations. RESULTS A novel compound heterozygous mutation of SLC12A3 gene (c.1712T > C in exon14 and c.2986_2987ins GCT in exon26) was identified by genetic testing in the proband. Moreover, we demonstrated that two brothers shared the same heterozygous mutation with the proband, but only one brother had the GS related symptoms. His nephew was the carrier of one mutation (c.1712T > C), and one of his brother, his sister and niece were carriers of the other (c.2986_2987ins GCT). CONCLUSIONS This is the first study to report the novel pathogenic compound heterozygous mutation of SLC12A3 gene in GS. Our result further supports the lack of phenotype-genotype correlations in GS. Further functional studies are required to investigate pathophysiologic mechanisms of GS.
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Affiliation(s)
- Minglan Yang
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Ying Dong
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Jianqing Tian
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Li Yan
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Yawen Chen
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Huiying Qiu
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Wei Liu
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Yaomin Hu
- Department of Endocrinology and Metabolic Diseases, Renji Hospital, Shanghai Jiaotong University, School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
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14
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Urwin S, Willows J, Sayer JA. The challenges of diagnosis and management of Gitelman syndrome. Clin Endocrinol (Oxf) 2020; 92:3-10. [PMID: 31578736 DOI: 10.1111/cen.14104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/13/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
Gitelman syndrome is an inherited tubulopathy characterized by renal salt wasting from the distal convoluted tubule. Defects in the sodium chloride cotransporter (encoded by SLC12A3) underlie this autosomal recessive condition. This article focuses on the specific challenges of diagnosing and treating Gitelman syndrome, with use of an illustrative case report. Symptoms relate to decreased serum potassium and magnesium levels, which include muscle weakness, tetany, fatigue and palpitations. Sudden cardiac deaths have been reported. Making a diagnosis may be difficult given its rarity but is important. A knowledge of the serum and urine biochemical picture is vital to distinguish it from a broad differential diagnosis, and application of genetic testing can resolve difficult cases. There is a group of Gitelman syndrome heterozygous carriers that experience symptoms and electrolyte disturbance and these patients should be managed in a similar way, though here genetic investigations become key in securing a difficult diagnosis. Potassium and magnesium replacement is the cornerstone of treatment, though practically this can be hard for patients to manage and often does not fully relieve symptoms even when serum levels are normalized. Challenges arise due to the lack of randomized controlled trials focussing on treatment of this rare disease; hence, clinicians endorse strategies in line with correction of the underlying pathophysiology such as sodium loading or pharmacological treatments, which seem to help some patients. Focussed dietary advice and knowing the best tolerated preparations of potassium and magnesium medications are useful tools for the physician, as well as an awareness of the specific burdens that this patient group face in order to signpost appropriate support.
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Affiliation(s)
- Stephanie Urwin
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jamie Willows
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John A Sayer
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
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15
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Al Banna R, Husain A, Al-Ghamdi B. Ventricular arrhythmia and tachycardia-induced cardiomyopathy in Gitelman syndrome, hypokalaemia is not the only culpable. BMJ Case Rep 2019; 12:12/12/e232086. [PMID: 31843774 DOI: 10.1136/bcr-2019-232086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gitelman syndrome (GS) is an autosomal recessive tubulopathy recently implicated in cases with ventricular arrhythmias (VAs), the latter being considered linked to electrolytes' imbalance. However, a direct causal relationship is considered to be an oversimplification for a complex molecular dysfunction. Recent work has suggested a degree of microvascular dysfunction in patients with GS that might be attributed as a mechanism of arrhythmia. We report a case of GS presenting with VAs complicated by cardiomyopathy. The high load of premature ventricular contractions that were attributed to the hypokalaemia has masked the presence of the left ventricular (LV) outflow tract tachycardia. Her LV systolic function recovered after successful electrophysiology ablation procedure. Atrioventricular nodal re-entry tachycardia was discovered incidentally during the study and was ablated successfully.
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Affiliation(s)
- Rashed Al Banna
- Medical Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Aysha Husain
- Internal Medicine cardiology unit, Salmaniya Medical Complex, Manama, Bahrain
| | - Bandar Al-Ghamdi
- Heart Centre, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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16
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Masab M, Goyal A, Abrol S, Rangaswami J. Acquired Gitelman Syndrome Associated with Systemic Sclerosis. Cureus 2019; 11:e3923. [PMID: 30931194 PMCID: PMC6430306 DOI: 10.7759/cureus.3923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Gitelman syndrome is an inherited renal disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria and metabolic alkalosis linked to the genes encoding the thiazide sensitive NaCl cotransporter (NCCT) located on the distal convoluted tubule of the kidney. It usually presents in late childhood or early adulthood with electrolyte abnormalities resembling chronic thiazide diuretic use. Acquired Gitelman syndrome is a very rare disorder mostly associated with Sjogren’s syndrome.
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Affiliation(s)
- Muhammad Masab
- Internal Medicine, West Virginia University, Morgantown, USA
| | - Abhinav Goyal
- Internal Medicine, Einstein Medical Center, Philadelphia, USA
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17
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Tsukakoshi T, Lin L, Murakami T, Shiono J, Izumi I, Horigome H. Persistent QT Prolongation in a Child with Gitelman Syndrome and SCN5A H558R Polymorphism. Int Heart J 2018; 59:1466-1468. [PMID: 30305584 DOI: 10.1536/ihj.17-686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gitelman syndrome (GS) is an inherited renal tubular disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and low urinary calcium excretion. While it is considered a benign disease, severe ventricular arrhythmia and sudden cardiac death related to the prolongation of the QT interval have been reported in rare cases. Herein we report a 13-year-old girl with GS who presented with persistent prolongation of the QT interval, even after being treated for hypokalemia and hypomagnesemia. Genetic analysis identified SCN5A H558R polymorphism, which modulates the function of myocardial sodium channel, and SLC12A3 A588V mutation, which causes GS. The SCN5A polymorphism and GS-related electrolyte disturbance might have contributed to the persistent QT prolongation in this patient. Although no ventricular arrhythmias were recorded in this case, careful cardiac surveillance should be applied for avoiding life-threatening cardiac events.
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Affiliation(s)
| | - Lisheng Lin
- Department of Pediatric Cardiology, Ibaraki Children's Hospital.,Department of Child Health, University of Tsukuba
| | | | - Junko Shiono
- Department of Pediatric Cardiology, Ibaraki Children's Hospital
| | - Isho Izumi
- Department of Pediatrics, Ibaraki Children's Hospital
| | - Hitoshi Horigome
- Department of Pediatric Cardiology, Ibaraki Children's Hospital.,Department of Child Health, University of Tsukuba
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18
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Tangvoraphonkchai K, Davenport A. Magnesium and Cardiovascular Disease. Adv Chronic Kidney Dis 2018; 25:251-260. [PMID: 29793664 DOI: 10.1053/j.ackd.2018.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
Magnesium is the most abundant intracellular divalent cation and essential for maintaining normal cellular physiology and metabolism, acting as a cofactor of numerous enzymes, regulating ion channels and energy generation. In the heart, magnesium plays a key role in modulating neuronal excitation, intracardiac conduction, and myocardial contraction by regulating a number of ion transporters, including potassium and calcium channels. Magnesium also has a role in regulating vascular tone, atherogenesis and thrombosis, vascular calcification, and proliferation and migration of endothelial and vascular smooth muscle cells. As such, magnesium potentially has a major influence on the pathogenesis of cardiovascular disease. As the kidney is a major regulator of magnesium homeostasis, kidney disorders can potentially lead to both magnesium depletion and overload, and as such increase the risk of cardiovascular disease. Observational data have shown an association between low serum magnesium concentrations or magnesium intake and increased atherosclerosis, coronary artery disease, arrhythmias, and heart failure. However, major trials of supplementation with magnesium have reported inconsistent benefits and also raised potential adverse effects of magnesium overload. As such, there is currently no firm recommendation for routine magnesium supplementation except when hypomagnesemia has been proven or suspected as a cause for cardiac arrhythmias.
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19
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Nabi Aslan A, Sivri S, Can Güney M, Keleş Prof T. Coexistence of Gitelman Syndrome and Hypertrophic Cardiomyopathy in a Pregnant Woman. ACTA CARDIOLOGICA SINICA 2018; 34:92-95. [PMID: 29375229 DOI: 10.6515/acs.201801_34(1).20170515a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gitelman syndrome (GS) is transmitted as an autosomal recessive trait and characterized by hypokalemic metabolic alkalosis in combination with significant hypomagnesemia and low urinary calcium excretion. The symptoms and severity of the disease can vary greatly from one person to another and can range from mild to severe. Sudden cardiac arrest has been reported occasionally as well. Here, for the first time, we reported a 34-year-old pregnant GS woman who was diagnosed to have hypertrophic obstructive cardiomyopathy during her cardiac examination for the complaints of palpitation and presyncope.
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Affiliation(s)
| | - Serkan Sivri
- Department of Cardiology, Atatürk Education and Research Hospital
| | - Murat Can Güney
- Faculty of Medicine, Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Telat Keleş Prof
- Faculty of Medicine, Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
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20
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Blanchard A, Bockenhauer D, Bolignano D, Calò LA, Cosyns E, Devuyst O, Ellison DH, Karet Frankl FE, Knoers NVAM, Konrad M, Lin SH, Vargas-Poussou R. Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2017; 91:24-33. [PMID: 28003083 DOI: 10.1016/j.kint.2016.09.046] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/14/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022]
Abstract
Gitelman syndrome (GS) is a rare, salt-losing tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The disease is recessively inherited, caused by inactivating mutations in the SLC12A3 gene that encodes the thiazide-sensitive sodium-chloride cotransporter (NCC). GS is usually detected during adolescence or adulthood, either fortuitously or in association with mild or nonspecific symptoms or both. The disease is characterized by high phenotypic variability and a significant reduction in the quality of life, and it may be associated with severe manifestations. GS is usually managed by a liberal salt intake together with oral magnesium and potassium supplements. A general problem in rare diseases is the lack of high quality evidence to inform diagnosis, prognosis, and management. We report here on the current state of knowledge related to the diagnostic evaluation, follow-up, management, and treatment of GS; identify knowledge gaps; and propose a research agenda to substantiate a number of issues related to GS. This expert consensus statement aims to establish an initial framework to enable clinical auditing and thus improve quality control of care.
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Affiliation(s)
- Anne Blanchard
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Centre d'Investigation Clinique, Paris, France; Centre d'Investigation Clinique 1418, Institut National de la Santé et de la Recherche Médicale, Paris, France; UMR 970, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Detlef Bockenhauer
- Centre for Nephrology, University College London, London, UK; Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - Davide Bolignano
- Institute of Clinical Physiology, National Research Council, Reggio, Calabria, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padova, Padova, Italy
| | | | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - David H Ellison
- Division of Nephrology and Hypertension, Oregon Health and Science University, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Fiona E Karet Frankl
- Department of Medical Genetics, University of Cambridge and Cambridge University Hospitals National Health Service Trust, Cambridge, UK; Division of Renal Medicine, University of Cambridge and Cambridge University Hospitals National Health Service Trust, Cambridge, UK
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Rosa Vargas-Poussou
- Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Centre d'Investigation Clinique, Paris, France; Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Paris, France
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21
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Xia MF, Bian H, Liu H, Wu HJ, Zhang ZG, Lu ZQ, Gao X. Hypokalemia, hypomagnesemia, hypocalciuria, and recurrent tetany: Gitelman syndrome in a Chinese pedigree and literature review. Clin Case Rep 2017; 5:578-586. [PMID: 28469853 PMCID: PMC5412754 DOI: 10.1002/ccr3.874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/26/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022] Open
Abstract
Gitelman syndrome is an autosomal recessive disease mostly associated with loss‐of‐function mutations of the SLC12A3 gene and featured by clinical hypokalemia, hypomagnesemia, hypocalciuria, and histologically hypertrophy of the juxtaglomerular apparatus. A novel homozygous mutation (p.Arg399Pro) at the extracellular domain of SLC12A3 was found and correlated with the severe clinical manifestations.
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Affiliation(s)
- Ming-Feng Xia
- Department of Endocrinology and Metabolism Zhongshan Hospital Fudan University Shanghai China
| | - Hua Bian
- Department of Endocrinology and Metabolism Zhongshan Hospital Fudan University Shanghai China
| | - Hong Liu
- Department of Nephrology Zhongshan Hospital Fudan University Shanghai China
| | - Hui-Juan Wu
- Department of Pathology School of Basic Medical Sciences Fudan University Shanghai China
| | - Zhi-Gang Zhang
- Department of Pathology School of Basic Medical Sciences Fudan University Shanghai China
| | - Zhi-Qiang Lu
- Department of Endocrinology and Metabolism Zhongshan Hospital Fudan University Shanghai China
| | - Xin Gao
- Department of Endocrinology and Metabolism Zhongshan Hospital Fudan University Shanghai China
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22
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Blanchard A, Vargas-Poussou R, Vallet M, Caumont-Prim A, Allard J, Desport E, Dubourg L, Monge M, Bergerot D, Baron S, Essig M, Bridoux F, Tack I, Azizi M. Indomethacin, amiloride, or eplerenone for treating hypokalemia in Gitelman syndrome. J Am Soc Nephrol 2014; 26:468-75. [PMID: 25012174 DOI: 10.1681/asn.2014030293] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Patients with Gitelman syndrome (GS), an inherited salt-losing tubulopathy, are usually treated with potassium-sparing diuretics or nonsteroidal anti-inflammatory drugs and oral potassium and magnesium supplementations. However, evidence supporting these treatment options is limited to case series studies. We designed an open-label, randomized, crossover study with blind end point evaluation to compare the efficacy and safety of 6-week treatments with one time daily 75 mg slow-release indomethacin, 150 mg eplerenone, or 20 mg amiloride added to constant potassium and magnesium supplementation in 30 patients with GS (individual participation: 48 weeks). Baseline plasma potassium concentration was 2.8±0.4 mmol/L and increased by 0.38 mmol/L (95% confidence interval [95% CI], 0.23 to 0.53; P<0.001) with indomethacin, 0.15 mmol/L (95% CI, 0.02 to 0.29; P=0.03) with eplerenone, and 0.19 mmol/L (95% CI, 0.05 to 0.33; P<0.01) with amiloride. Fifteen patients became normokalemic: six with indomethacin, three with eplerenone, and six with amiloride. Indomethacin significantly reduced eGFR and plasma renin concentration. Eplerenone and amiloride each increased plasma aldosterone by 3-fold and renin concentration slightly but did not significantly change eGFR. BP did not significantly change. Eight patients discontinued treatment early because of gastrointestinal intolerance to indomethacin (six patients) and hypotension with eplerenone (two patients). In conclusion, each drug increases plasma potassium concentration in patients with GS. Indomethacin was the most effective but can cause gastrointestinal intolerance and decreased eGFR. Amiloride and eplerenone have similar but lower efficacies and increase sodium depletion. The benefit/risk ratio of each drug should be carefully evaluated for each patient.
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Affiliation(s)
- Anne Blanchard
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Paris, France;
| | - Rosa Vargas-Poussou
- Département de génétique and Institut National de la Santé et de la Recherche Médicale, UMR970, Paris-Cardiovascular Research Center, Paris, France
| | - Marion Vallet
- Service des explorations fonctionnelles physiologiques, Hôpital de Rangueil, Toulouse, France
| | - Aurore Caumont-Prim
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Épidémiologique 4, Paris, France
| | - Julien Allard
- Centre Hospitalier Universitaire Dupuytren, Service de néphrologie, Centre d'Investigation Clinique Centre d'Investigation Clinique Institut National de la Santé et de la Recherche Médicale 0801, Limoges, France
| | - Estelle Desport
- Centre Hospitalier Universitaire de Poitiers, Service de néphrologie, Centre d'Investigation Clinique Centre d'Investigation Clinique Institut National de la Santé et de la Recherche Médicale 1402, Université de Poitiers, Poitiers, France; and
| | - Laurence Dubourg
- Hôpital Edouard Herriot, Lyon, Paris, Hospices civils de Lyon, Lyon, France
| | - Matthieu Monge
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, Paris, France
| | - Damien Bergerot
- Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Paris, France
| | - Stéphanie Baron
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France; Service d'explorations fonctionnelles, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Essig
- Centre Hospitalier Universitaire Dupuytren, Service de néphrologie, Centre d'Investigation Clinique Centre d'Investigation Clinique Institut National de la Santé et de la Recherche Médicale 0801, Limoges, France
| | - Frank Bridoux
- Centre Hospitalier Universitaire de Poitiers, Service de néphrologie, Centre d'Investigation Clinique Centre d'Investigation Clinique Institut National de la Santé et de la Recherche Médicale 1402, Université de Poitiers, Poitiers, France; and
| | - Ivan Tack
- Service des explorations fonctionnelles physiologiques, Hôpital de Rangueil, Toulouse, France
| | - Michel Azizi
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Paris, France
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23
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Goswami RP, Mandal S, Karmakar PS, Ghosh A. Diuretic loading test and use of Bartter's Normogram in diagnosing a case of Gitelman's syndrome: Relook into pathophysiology. Indian J Nephrol 2011; 21:289-92. [PMID: 22022094 PMCID: PMC3193677 DOI: 10.4103/0971-4065.83748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gitelman's syndrome is a rare autosomal recessive, renal tubular disorder, characterized by chronic hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria, and normal blood pressure. Patients usually present at a later age with episodic mild muscle weakness. Unexplained hypokalemia arouses suspicion. The diuretic loading test with furosemide and thiazide and the use of Bartter's normogram provides a practical and simple tool in comparison to the complex and costly genetic analysis, to confirm the diagnosis. Here we report a case of Gitelman's syndrome to show the utility of these simple techniques to explain the pathophysiology of the disease, as well as to localize the site of the renal tubular defect, to confirm the diagnosis.
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Affiliation(s)
- R P Goswami
- Department of Internal Medicine, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
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24
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Sinha A, Lněnička P, Basu B, Gulati A, Hari P, Bagga A. Gitelman syndrome: novel mutation and long-term follow-up. Clin Exp Nephrol 2011; 16:306-9. [PMID: 21964762 DOI: 10.1007/s10157-011-0542-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
We report a case of Gitelman syndrome presenting with fatigue, paresthesias, weakness of limbs and neck muscles since 2.5 years of age. Investigations showed hypokalemia and hypomagnesemia with urinary magnesium wasting. Genetic analysis revealed the presence of a novel homozygous mutation in the SLC12A3 gene (c.2879_2883+9ins14bp, p.Val 960 Glu fsx12). Management with potassium and magnesium supplements and spironolactone resulted in a significant improvement in symptoms. Over a follow-up of 11 years, the patient showed satisfactory growth and physical development.
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Affiliation(s)
- Aditi Sinha
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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25
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Seyberth HW, Schlingmann KP. Bartter- and Gitelman-like syndromes: salt-losing tubulopathies with loop or DCT defects. Pediatr Nephrol 2011; 26:1789-802. [PMID: 21503667 PMCID: PMC3163795 DOI: 10.1007/s00467-011-1871-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 12/11/2022]
Abstract
Salt-losing tubulopathies with secondary hyperaldosteronism (SLT) comprise a set of well-defined inherited tubular disorders. Two segments along the distal nephron are primarily involved in the pathogenesis of SLTs: the thick ascending limb of Henle's loop, and the distal convoluted tubule (DCT). The functions of these pre- and postmacula densa segments are quite distinct, and this has a major impact on the clinical presentation of loop and DCT disorders - the Bartter- and Gitelman-like syndromes. Defects in the water-impermeable thick ascending limb, with its greater salt reabsorption capacity, lead to major salt and water losses similar to the effect of loop diuretics. In contrast, defects in the DCT, with its minor capacity of salt reabsorption and its crucial role in fine-tuning of urinary calcium and magnesium excretion, provoke more chronic solute imbalances similar to the effects of chronic treatment with thiazides. The most severe disorder is a combination of a loop and DCT disorder similar to the enhanced diuretic effect of a co-medication of loop diuretics with thiazides. Besides salt and water supplementation, prostaglandin E2-synthase inhibition is the most effective therapeutic option in polyuric loop disorders (e.g., pure furosemide and mixed furosemide-amiloride type), especially in preterm infants with severe volume depletion. In DCT disorders (e.g., pure thiazide and mixed thiazide-furosemide type), renin-angiotensin-aldosterone system (RAAS) blockers might be indicated after salt, potassium, and magnesium supplementation are deemed insufficient. It appears that in most patients with SLT, a combination of solute supplementation with some drug treatment (e.g., indomethacin) is needed for a lifetime.
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Affiliation(s)
- Hannsjörg W. Seyberth
- Department of Pediatrics and Adolescent Medicine, Philipps University, Marburg, Germany ,Lazarettgarten 23, 76829 Landau, Germany
| | - Karl P. Schlingmann
- Department of General Pediatrics, University Children’s Hospital, Münster, Germany
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26
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Christov M, Alper SL. Tubular transport: core curriculum 2010. Am J Kidney Dis 2010; 56:1202-17. [PMID: 21035933 DOI: 10.1053/j.ajkd.2010.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/14/2010] [Indexed: 12/31/2022]
Affiliation(s)
- Marta Christov
- Renal Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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27
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Cortesi C, Lava SAG, Bettinelli A, Tammaro F, Giannini O, Caiata-Zufferey M, Bianchetti MG. Cardiac arrhythmias and rhabdomyolysis in Bartter-Gitelman patients. Pediatr Nephrol 2010; 25:2005-8. [PMID: 20549246 DOI: 10.1007/s00467-010-1580-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 05/11/2010] [Accepted: 05/17/2010] [Indexed: 11/28/2022]
Abstract
Recent data demonstrate that patients affected with hypokalemic salt-losing tubulopathies are prone to acute cardiac arrhythmias and rhabdomyolysis. The tendency to these potentially fatal complications is especially high if chronic hypokalemia is severe, in patients with diarrhea, vomiting or a prolonged QT interval on standard electrocardiography, in patients on drug management with compounds prolonging the electrocardiographic QT interval (including antiarrhythmic agents, some antihistamines, macrolides, antifungals, psychotropics, beta2-adrenergic agonists or cisapride), following acute alcohol abuse and during exercise. Cardiac arrhythmias and rhabdomyolysis occur with sufficient frequency in hypokalemic salt-losing tubulopathies to merit wider awareness of their presence and the preparation of specific prevention and management recommendations.
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Bansal T, Abeygunasekara S, Ezzat V. An unusual presentation of primary renal hypokalemia-hypomagnesemia (Gitelman's syndrome). Ren Fail 2010; 32:407-10. [PMID: 20370462 DOI: 10.3109/08860221003632873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gitelman's syndrome, or congenital hypokalemic hypomagnesemic hypocalciuria with metabolic alkalosis, is widely described as a benign or milder variant of Bartter's syndrome and most commonly presents with transient periods of weakness and fatigue, presyncope, vertigo, ataxia, and blurred vision, though aborted sudden cardiac death has also been rarely reported. Despite this there are limited data in the literature regarding the formal cardiac evaluation of patients with Gitelman's syndrome. We present the case of a gentleman with Gitelman's syndrome who initially presented to his primary physician with symptoms suggestive of an upper respiratory tract infection and subsequently survived a ventricular fibrillation (VF) cardiac arrest in the community. We review the literature regarding possible life-threatening cardiac complications in these patients.
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Affiliation(s)
- Tarun Bansal
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, South Yorkshire, UK.
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Bansal R, Ranga VK. Acquired Gitelman's syndrome: an oxymoron? Int Urol Nephrol 2010; 43:233-6. [PMID: 20306297 DOI: 10.1007/s11255-010-9727-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 03/03/2010] [Indexed: 11/24/2022]
Abstract
We present the case of a 27-year-old woman with end stage renal disease from Diabetes Mellitus type 1 who had been on hemodialysis for a year. Her father, who was otherwise healthy, was evaluated as a possible living donor. Incidentally, during the workup process, he was identified as having Gitelman's syndrome (GS). The transplant proceeded without any complications, following which the recipient developed biochemical abnormalities consistent with GS. Both donor and recipient are doing well at this time. To our knowledge, this is the only known case of kidney donation by a patient with GS either living or deceased.
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Affiliation(s)
- Renu Bansal
- University of Connecticut Health Center, Farmington, CT, USA,
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Scognamiglio R, Calò LA, Negut C, Coccato M, Mormino P, Pessina AC. Myocardial perfusion defects in Bartter and Gitelman syndromes. Eur J Clin Invest 2008; 38:888-95. [PMID: 19021712 DOI: 10.1111/j.1365-2362.2008.02034.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Normotensive hypokalaemic tubulopathies (Bartter and Gitelman syndromes (BS/GS)) are genetic diseases that are considered benign. However, QT prolongation, left ventricular dysfunction and reduction of cardiac index upon exercise leading to arrhythmias and sudden cardiac death have been reported in these patients. Hence, we aimed to verifying whether an isometric exercise could represent a useful tool for the identification of patients at risk for future cardiac events. PATIENTS AND METHODS Myocardial function (MF) and perfusion, evaluated as myocardial blood flow (MBF) of 10 BS/GS patients and 10 healthy controls, were investigated at rest and during isometric exercise. MF and MBF were evaluated using quantitative two-dimensional and myocardial contrast echocardiography. RESULTS BS/GS patients had normal baseline MF and MBF. During exercise in BS/GS patients, corrected QT (QTc) was prolonged to peak value of 494 +/- 9.1 ms (P < 0.001). In controls, MF increased from resting to peak exercise (left ventricular ejection fraction: 65 +/- 4% to 78 +/- 5%, P < 0.003) while in seven BS/GS patients (Group 1) it declined (64 +/- 5% to 43 +/- 9%, P < 0.001). Myocardial perfusion increased upon exercise in controls as shown by changes of its markers: beta (a measure of myocardial flow velocity; 0.89 +/- 0.12 vs. 0.99 +/- 0.12, P < 0.001) and myocardial blood volume (14.4 +/- 2 vs. 20.2 +/- 0.25, P < 0.001), while in Group 1 BS/GS it decreased (0.87 +/- 0.15 vs. 0.67 +/- 0.15, P < 0.001; and 14.5 +/- 1.9 vs. 8.3 +/- 0.22, P < 0.001, respectively). CONCLUSIONS Our results document for the first time that exercise induce coronary microvascular and myocardial defects in BS/GS patients. Therefore, this may challenge the idea that BS/GS are benign diseases. In addition, the diagnostic approach to these syndromes should include an in-depth cardiac assessment in order to identify patients at higher risk.
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Affiliation(s)
- R Scognamiglio
- Policlinico Abano Terme, Metabolic Cardiology, University Hospital, University of Padova, Padova, Italy
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Montagnana M, Lippi G, Franchini M, Targher G, Cesare Guidi G. Sudden cardiac death: prevalence, pathogenesis, and prevention. Ann Med 2008; 40:360-75. [PMID: 18484348 DOI: 10.1080/07853890801964930] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death (SCD), also known as sudden arrest, is a major health problem worldwide. It is usually defined as an unexpected death from a cardiac cause occurring within a short time in a person with or without preexisting heart disease. The pathogenesis of SCD is complex and multifaceted. A dynamic triggering factor usually interacts with an underlying heart disease, either genetically determined or acquired, and the final outcome is the development of lethal tachyarrhythmias or, less frequently, bradycardia. It has increasingly been highlighted that a reliable clinical and diagnostic approach might be effective to unmask the most important genetic and environmental factors, allowing the construction of a rational personalized medicine framework that can be applied in both the preclinical and clinical settings of SCD. The aim of the present article is to provide a concise overview of prevalence, pathogenesis, clinical presentation, and diagnostic approach to this challenging disorder.
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Affiliation(s)
- Martina Montagnana
- Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Universita degli Studi di Verona, Italy.
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Joo KW, Lee JW, Jang HR, Heo NJ, Jeon US, Oh YK, Lim CS, Na KY, Kim J, Cheong HI, Han JS. Reduced urinary excretion of thiazide-sensitive Na-Cl cotransporter in Gitelman syndrome: preliminary data. Am J Kidney Dis 2007; 50:765-73. [PMID: 17954289 DOI: 10.1053/j.ajkd.2007.07.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 07/31/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between SLC12A3 mutations and actual sodium-chloride (Na-Cl) cotransporter (NCC) expression in patients with Gitelman syndrome (GS) was rarely evaluated. Detection of urinary thiazide-sensitive NCC was not tried in patients with GS. STUDY DESIGN Case series. SETTING & PARTICIPANTS 6 patients with GS and 1 patient with surreptitious vomiting. OUTCOMES & MEASUREMENTS Renal clearance study, mutation analysis using reverse-transcription polymerase chain reaction and direct sequencing for the SLC12A3 gene, and immunohistochemical staining for NCC, Na-K-2Cl-cotransporter, alpha1-subunit of Na(+),K(+)-ATPase, and calbindin-D(28K) of the renal biopsy specimens were performed. Membrane fractions of urine were obtained by using differential centrifugation and probed with antibodies against human NCC and aquaporin 2. RESULTS Results of clearance studies were consistent with GS, showing decreased distal fractional chloride reabsorption with only furosemide. SLC12A3 gene mutations were found in all patients with GS. Immunohistochemistry showed markedly decreased NCC expression in the distal convoluted tubule, whereas expression of other transporters remained intact. Urinary NCC excretion was markedly decreased in patients with GS, but not in the patient with surreptitious vomiting. LIMITATIONS Small number of patients and lack of mutation analysis of CLCNKB. CONCLUSIONS There were no relations between NCC expression and types of mutations. Detection of urinary NCC might be helpful for the differential diagnosis of GS.
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Affiliation(s)
- Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Chongno-gu, Seoul, Korea
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Riveira-Munoz E, Chang Q, Bindels RJ, Devuyst O. Gitelman's syndrome: towards genotype-phenotype correlations? Pediatr Nephrol 2007; 22:326-32. [PMID: 17061123 DOI: 10.1007/s00467-006-0321-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 08/15/2006] [Accepted: 08/24/2006] [Indexed: 12/18/2022]
Abstract
Gitelman's syndrome (GS) is a salt-losing tubulopathy characterized by hypokalemic alkalosis with hypomagnesemia and hypocalciuria. The disease is associated with inactivating mutations in the SLC12A3 gene that codes for the thiazide-sensitive Na+-Cl- cotransporter (NCCT) that is expressed in the apical membrane of the cells lining the distal convoluted tubule (DCT). GS is relatively frequent, and more than 100 mutations scattered through SLC12A3 have been identified thus far. Although the disease is recessively inherited, up to 40% of patients are found to carry only a single mutation, instead of being compound heterozygous or homozygous. The phenotype of GS is highly heterogeneous in terms of age at presentation, and nature/severity of the biochemical abnormalities and clinical manifestations. This phenotypical heterogeneity is observed not only between all patients harbouring SLC12A3 mutations but also among family members or patients with identical mutations. In this review, we discuss the potential explanations for the failure to identify mutant alleles in SLC12A3, as well as the different mechanisms that can account for the inter- and intra-familial phenotype variability in GS, including genetic heterogeneity, position and nature of the mutations, functional consequences, compensatory mechanisms, and modifying genes.
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Riveira-Munoz E, Chang Q, Godefroid N, Hoenderop JG, Bindels RJ, Dahan K, Devuyst O. Transcriptional and functional analyses of SLC12A3 mutations: new clues for the pathogenesis of Gitelman syndrome. J Am Soc Nephrol 2007; 18:1271-83. [PMID: 17329572 DOI: 10.1681/asn.2006101095] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gitelman syndrome (GS) is a recessive salt-losing tubulopathy that is caused by mutations in the SLC12A3 gene that encodes the sodium-chloride co-transporter (NCC). GS is characterized by significant inter- and intrafamilial phenotype variability, with early onset and/or severe clinical manifestations in some patients. No correlations between the disease variability and the position/nature of SLC12A3 mutations have been investigated thus far. In this study, extensive mutational analyses of SLC12A3 were performed in 27 patients with GS, including genomic DNA sequencing, multiplex ligation-dependent probe amplification, cDNA analysis, and quantification of allele-specific transcripts, in parallel with functional analyses in Xenopus laevis oocytes and detailed phenotyping. Twenty-six SLC12A3 mutations were identified in 25 patients with GS, including eight novel (detection rate 80%). Transcript analysis demonstrated that splicing mutations of SLC12A3 lead to frameshifted mRNA subject to degradation by nonsense-mediated decay. Heterologous expression documented a novel class of NCC mutants with defective intrinsic transport activity. A subgroup of patients presented with early onset, growth retardation, and/or detrimental manifestations, confirming the potential severity of GS. The mutations that were associated with a severe presentation were the combination at least for one allele of a missplicing resulting in a truncated transcript that was downregulated by nonsense-mediated decay or a nonfunctional, cell surface-absent mutant. The most recurrent mutation on the second allele was a newly described NCC mutant that affected the functional properties of the co-transporter. These data suggest that the nature/position of SLC12A3 mutation, combined with male gender, is a determinant factor in the severity of GS and provide new insights in the underlying pathogenic mechanisms of the disease.
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Affiliation(s)
- Eva Riveira-Munoz
- Division of Nephrology, Université Catholique de Louvain Medical School, Brussels, Belgium
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Hanevold C, Mian A, Dalton R. C1q nephropathy in association with Gitelman syndrome: a case report. Pediatr Nephrol 2006; 21:1904-8. [PMID: 16955279 DOI: 10.1007/s00467-006-0261-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 12/18/2022]
Abstract
There have been rare reports of glomerulopathies developing in patients with Bartter syndrome (BS) and its milder variant, Gitelman syndrome (GS). We present the first case of C1q nephropathy (C1qN) in an African American child with GS. This child was diagnosed with GS at 9 years of age and subsequently developed nephrotic range proteinuria 3 years later. Renal biopsy revealed mesangial hypercellularity and focal segmental glomerulosclerosis (FSGS). The segmental lesions were generally located at the vascular pole. Dominant C1q (2+) staining along with IgG (1-2+) was demonstrated in the mesangium, which correlated with scattered electron dense mesangial deposits demonstrated by electron microscopy. Treatment with an angiotensin-converting enzyme inhibitor led to an improvement in proteinuria to near-normal values (urine protein/creatinine ratio down to 0.5), but the creatinine clearance declined to approximately 58 ml/min/1.73 m(2). This case highlights the possible association between the milder hypokalemic tubulopathy, GS, and glomerular disease, including C1qN. Prompt evaluation of proteinuria with renal biopsy in these patients is recommended to detect significant glomerular pathology. Further research is needed to define risk factors for this complication.
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Affiliation(s)
- Coral Hanevold
- Department of Pediatrics, Medical College of Georgia, BG 2071, 1120 15th St., Augusta, GA 30912-3795, USA.
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Hashida T, Yamada M, Hashimoto K, Satoh T, Okada S, Shibusawa N, Ishizuka T, Mori M. Loss of consciousness and hypokalemia in an elderly man with a mutation of the thiazide-sensitive Na-Cl cotransporter gene. Endocr J 2006; 53:859-63. [PMID: 16966826 DOI: 10.1507/endocrj.k06-076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An 80-year-old man was referred to our department for evaluation of repetitive loss of consciousness and faintness with hypokalemia. He had relatively low blood pressure, hypomagnesemia, hypocalciuria and chondrocalcinosis in the knee, clinically suggesting Gitelman's syndrome. A renal clearance study could not be carried out due to the patient's age and complications of the heart. Sequence analysis of the gene of thiazide-sensitive Na-Cl cotransporter (TSC) showed a heterozygous missense mutation from C to T at 1712 base pairs from the translation start site, with resultant changes in codon 569 from alanine to valine (A569V). Treatment with oral administration of potassium chloride improved all the symptoms. Although Gitelman's syndrome has been considered to be autosomal recessive, cases of only heterozygous mutation detected have recently been reported. Therefore, the mutation found in this patient may be responsible for Gitelman's syndrome.
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Affiliation(s)
- Tetsu Hashida
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Godefroid N, Riveira-Munoz E, Saint-Martin C, Nassogne MC, Dahan K, Devuyst O. A Novel Splicing Mutation in SLC12A3 Associated With Gitelman Syndrome and Idiopathic Intracranial Hypertension. Am J Kidney Dis 2006; 48:e73-9. [PMID: 17059986 DOI: 10.1053/j.ajkd.2006.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 08/14/2006] [Indexed: 11/11/2022]
Abstract
We report a case of Gitelman syndrome (GS) in a dizygotic twin who presented at 12 years of age with growth delay, metabolic alkalosis, hypomagnesemia and hypokalemia with inappropriate kaliuresis, and idiopathic intracranial hypertension with bilateral papilledema (pseudotumor cerebri). The patient, her twin sister, and her mother also presented with cerebral cavernous malformations. Based on the early onset and normocalciuria, Bartter syndrome was diagnosed first. However, mutation analysis showed that the proband is a compound heterozygote for 2 mutations in SLC12A3: a substitution of serine by leucine at amino acid position 555 (p.Ser555Leu) and a novel guanine to cytosine transition at the 5' splice site of intron 22 (c.2633+1G>C), providing the molecular diagnosis of GS. These mutations were not detected in 200 normal chromosomes and cosegregated within the family. Analysis of complementary DNA showed that the heterozygous nucleotide change c.2633+1G>C caused the appearance of 2 RNA molecules, 1 normal transcript and 1 skipping the entire exon 22 (r.2521_2634del). Supplementation with potassium and magnesium improved clinical symptoms and resulted in catch-up growth, but vision remained impaired. Three similar associations of Bartter syndrome/GS with pseudotumor cerebri were found in the literature, suggesting that electrolyte abnormalities and secondary aldosteronism may have a role in idiopathic intracranial hypertension. This study provides further evidence for the phenotypical heterogeneity of GS and its association with severe manifestations in children. It also shows the independent segregation of familial cavernomatosis and GS.
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Affiliation(s)
- Nathalie Godefroid
- Department of Pediatrics, Division of Nephrology, Center for Human Genetics, Université catholique de Louvain Medical School, Saint-Luc Academic Hospital, Brussels, Belgium
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Abstract
In the past decade our understanding of the etiology and pathophysiology of Gitelman syndrome, an autosomal recessive salt-losing tubular disorder with secondary hypokalemia, has increased considerably through the achievements of molecular genetics and cell physiology. In this short review, I will summarize the most recent data on the clinical and biochemical phenotype, the molecular causes, and the pathogenesis of Gitelman syndrome. I will especially focus on the recent elucidation of the mechanisms involved in the pathogenesis of the hypomagnesemia and hypocalciuria that accompanies Gitelman syndrome.
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Affiliation(s)
- Nine V A M Knoers
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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