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Hanifa H, Ataya J, Abu-Naja M, Aborahhal A, Assaf N. Bartter syndrome in a female infant: A rare case report from Syria. SAGE Open Med Case Rep 2024; 12:2050313X241233117. [PMID: 38379632 PMCID: PMC10878210 DOI: 10.1177/2050313x241233117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Antenatal Bartter syndrome is a rare condition that affects approximately 1.2 individuals per million. It is caused by renal tubular dysfunction that impairs the reabsorption of sodium and chloride. This results in various symptoms such as polyuria, vomiting, dehydration, and failure to thrive. Because of its low prevalence, diagnosing this disorder can be challenging for medical professionals. In this report, we describe a rare case of a 3-month-old female infant who had symptoms of Bartter syndrome, such as severe hypotension, facial flattening, cough, and seizures. She also had the typical features of the condition, except for prematurity and hypercalciuria, which were not present. In this case, we highlight the importance of regular follow-ups and monitoring of patients with dehydration and electrolyte imbalances, as these can lead to complications in Bartter syndrome. Early intervention and close monitoring can enhance patient outcomes and avoid complications.
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Affiliation(s)
- Hamdah Hanifa
- Faculty of Medicine, University of Kalamoon, Al-Nabk, Syria
- Al-Dandashi National Group, Yaafour, Damascus, Syria
| | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Malak Abu-Naja
- Medical Biology, Al- Balqa’ Applied University (BAU), Zarqa, Jordan
| | - Ali Aborahhal
- Department of Traumatology and Orthopedics, Tartous University, Tartous, Syria
| | - Nihad Assaf
- CES De Nephrologie, University of Kalamoon, Damascus, Syria
- CES De Nephrologie, Syrian Private University, Damascus, Syria
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Walsh CJ, Micke K, Elfman H, Bock M, Harper T, Zaretsky M, Galan HL, Behrendt N, Putra M. Successful antenatal treatment of MAGED2-related Bartter syndrome and review of treatment options and efficacy. Prenat Diagn 2024; 44:172-179. [PMID: 38159268 DOI: 10.1002/pd.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
A new form of transient antenatal Bartter syndrome (aBS) was recently identified that is associated with the X-linked MAGED2 variant. Case reports demonstrate that this variant leads to severe polyhydramnios that may result in preterm birth or pregnancy loss. There is limited but promising evidence that amnioreductions may improve fetal outcomes in this rare condition. We report a woman with two affected pregnancies. In the first pregnancy, the patient was diagnosed with mild-to-moderate polyhydramnios in the second trimester that ultimately resulted in preterm labor and delivery at 25 weeks with fetal demise. Whole exome sequencing of the amniotic fluid sample resulted after the pregnancy loss and revealed a c.1337G>A MAGED2 variant that was considered diagnostically. The subsequent pregnancy was confirmed by chorionic villi sampling to also be affected by this variant. The pregnancy was managed with frequent ultrasounds and three amnioreductions that resulted in spontaneous vaginal delivery at 37 weeks and 6 days of a viable newborn with no evidence of overt electrolyte abnormalities suggesting complete resolution. A detailed review of the published cases of MAGED2-related transient aBS is provided. Our review focuses on individuals who received antenatal treatment. A total of 31 unique cases of MAGED2-related transient aBS were compiled. Amnioreduction was performed in 23 cases and in 18 cases no amnioreduction was performed. The average gestational age at delivery was significantly lower in cases without serial amnioreduction (28.7 vs. 30.71 weeks, p = 0.03). Neonatal mortality was seen in 5/18 cases without serial amnioreduction, and no mortality was observed in the cases with serial amnioreduction. In cases of second trimester severe polyhydramnios without identifiable cause, whole exome sequencing should be considered. Intensive ultrasound surveillance and serial amnioreduction is recommended for the management of MAGED2-related transient aBS.
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Affiliation(s)
- Caroline J Walsh
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kestutis Micke
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hannah Elfman
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margret Bock
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Pediatric Nephrology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Teresa Harper
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Zaretsky
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Henry L Galan
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicholas Behrendt
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manesha Putra
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Section of Genetics and Metabolism, Children's Hospital Colorado, Aurora, Colorado, USA
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Severe Bartter syndrome type 1: Prompt postnatal management thanks to antenatal identification of SLC12A1 pathogenic variants. Arch Pediatr 2022; 29:530-533. [PMID: 36058813 DOI: 10.1016/j.arcped.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/27/2022] [Accepted: 08/04/2022] [Indexed: 10/14/2022]
Abstract
Bartter syndrome (BS) refers to a group of hereditary kidney disorders. One antenatal form is Bartter syndrome type 1 (BS1), caused by pathogenic variants in the SLC12A1 gene. We report a case of BS1 presenting with severe polyhydramnios. The fetus was found to carry three pathogenic variants of SLC12A1, leading to the antenatal diagnosis of BS1 and its prompt management. At age 18 days, clinical conditions were complicated by the onset of sepsis requiring supportive measures as well as steroid and antibiotic therapy. Any newborn with an antenatal history of polyhydramnios or postnatal polyuria should be suspected of having BS, since delayed diagnosis may lead to rapid renal failure.
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Alajjuri OA, Samaha ME, Honemeyer U, Mohammed G, Mousa NA. Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report. Front Med (Lausanne) 2022; 9:870503. [PMID: 35847797 PMCID: PMC9276994 DOI: 10.3389/fmed.2022.870503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022] Open
Abstract
Background Bartter syndrome, a very rare inherited renal tubular disorder, characterized by urinary salt wastage, hypokalemia, polyuria, and metabolic alkalosis, may manifest antenatally as severe isolated polyhydramnios. Indomethacin is known to reduce salt wastage and subsequent polyhydramnios during pregnancy; however, it reduces the Ductus Arteriosus diameter among other potential complications, such as inhibition of gastrointestinal perfusion and increasing the risk of renal toxicity. Case A 36-year-old multigravida presented with severe isolated polyhydramnios at 30 weeks of gestation. Based on a history of a previous pregnancy affected with Bartter syndrome, indomethacin was initiated. Amniotic fluid volume and Ductus Arteriosus diameter were monitored. As evidence lacks on optimal dose and duration of indomethacin, multiple-dose adjustments were made to reduce the amniotic fluid volume while maintaining normal Ductus Arteriosus diameter. Progressive polyhydramnios led to Cesarean section at 34+ weeks of gestation resulting in a healthy fetus diagnosed with Bartter syndrome in the early neonatal period. Conclusion We share our experience in the adjustment of the dose and duration of Indomethacin therapy in the treatment of severe polyhydramnios associated with antenatal Bartter syndrome. Amniotic fluid index, Ductus Arteriosus diameter, and umbilical artery doppler work together as key indicators to guide the success and safety of the therapy.
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Affiliation(s)
- Omar Ala' Alajjuri
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mayar Essam Samaha
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ulrich Honemeyer
- New Medical Center (NMC) Royal Hospital Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Noha A. Mousa
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London S, Levine MA, Li D, Spiegel R, Lebel A, Halevy R, Tenenbaum-Rakover Y. Hypocalcemia as the Initial Presentation of Type 2 Bartter Syndrome: A Family Report. J Clin Endocrinol Metab 2022; 107:e1679-e1688. [PMID: 34751387 DOI: 10.1210/clinem/dgab821] [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: 09/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Bartter syndrome (BS) is a group of rare autosomal-recessive tubulopathies characterized by hypokalemic, hypochloremic metabolic alkalosis in which the primary defect is a deficiency of transporters involved in sodium chloride reabsorption. Type 2 BS results from a defect in the renal outer medullary potassium channel encoded by the KCNJ1 gene. Type 2 BS presents with polyhydramnios, intrauterine growth retardation, prematurity, failure to thrive, polyuria, hypercalciuria, and life-threatening episodes of dehydration. Hypocalcemia is a very rare presenting symptom of BS, with only a few published cases reporting it as the initial manifestation of type 2 BS. OBJECTIVE To describe a child who presented with hypocalcemic seizure at the age of 2.3 years that was first related to vitamin D deficiency and high-phosphate soft drink consumption. METHODS Whole exome sequencing (WES) was used to evaluate the biochemical abnormalities of the proband. RESULTS We identified a previously described homozygous missense mutation c.212C>T, p.T71M in the KCNJ1 gene associated with type 2 BS. Six additional family members with the same mutation and diagnosed clinically with BS are also reported, 2 presenting with hypocalcemia associated with vitamin D deficiency. CONCLUSION This report expands the clinical spectrum associated with KCNJ1 mutations and emphasizes the role of WES in unsolved cases of hypocalcemia when genetic disease is suspected. It also highlights the hazardous effects of phosphate-containing soft drinks on calcium metabolism.
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Affiliation(s)
- Shira London
- Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
- Armon Child Health Center, Clalit Health Services, Haifa, Israel
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Center for Bone Health, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronen Spiegel
- Pediatric Ward B, Ha'Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Asaf Lebel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Pediatric Nephrology Unit, Ha'Emek Medical Center, Afula, Israel
| | - Rephael Halevy
- Pediatric Nephrology Unit, Ha'Emek Medical Center, Afula, Israel
| | - Yardena Tenenbaum-Rakover
- Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Yang H, Liu Z, Wu Y, Xu J, He Y, Wang R, Zhang W, Chen D. Case Report: Transient antenatal bartter syndrome in an extremely preterm infant with a novel MAGED2 variant. Front Pediatr 2022; 10:1093268. [PMID: 36819197 PMCID: PMC9932885 DOI: 10.3389/fped.2022.1093268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Variants in the MAGED2 may cause antenatal transient Bartter syndrome, which is characterised by polyhydramnios, preterm labour, postnatal polyuria, hypokalaemia and metabolic alkalosis. Transient gross hematuria and acute kidney injury in such cases have not been reported previously. The patient, a boy, was born at a gestational age of 27 + 5 weeks. Polyhydramnios has been detected at 24 weeks of gestation. Polyuria, hyponatraemia, hypokalaemia, weight loss, transient hematuria and acute kidney injury occur after birth. The urinary ultrasonography showed no abnormality, and after a month of treatment with liquid electrolytes and nutritional management, the clinical symptoms improved. Whole-exome sequencing revealed a variant in MAGED2: c.1426C > T, p.Arg476X, inherited from the mother, who was healthy. During the 1-year follow-up, the child grew and developed with normal renal function and electrolyte levels. This is the first report of transient antenatal Bartter syndrome caused by a MAGED2 variant in China in an extremely preterm infant who exhibited previously unreported symptoms: transient hematuria and acute kidney injury. This newly found variant expands the spectrum of genetic variants associated with antenatal Bartter syndrome; it can be detected by early genetic testing and overmedication, thereby avoided.
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Affiliation(s)
- Hongyuan Yang
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Zhiyong Liu
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Yaying Wu
- Department of Plastic Surgery, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Jinglin Xu
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ying He
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ruiquan Wang
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Weifeng Zhang
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Dongmei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
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A Rare Cause of Refractory Severe Polyhydramnios: Antenatal Bartter Syndrome. ACTA ACUST UNITED AC 2021; 57:medicina57030272. [PMID: 33809664 PMCID: PMC8002264 DOI: 10.3390/medicina57030272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
Background: Antenatal Bartter syndrome is an autosomal recessive disorder causing severe polyuria that leads to severe polyhydramnios and preterm labor. Prenatal diagnosis of antenatal Bartter syndrome is difficult because the genetic diagnosis can only be confirmed following a clinical diagnosis in infants. Reports of prenatal diagnosis and treatment of antenatal Bartter syndrome are limited. Case Presentation: We present the case of a 33-year-old pregnant woman with refractory polyhydramnios at 31 weeks of gestation. There were no structural anomalies or placental problems on ultrasonography; therefore, antenatal Bartter syndrome was suspected. With repeated amniocentesis and indomethacin therapy, the pregnancy continued to 36 weeks of gestation. The clinical features of the infant and subsequent genetic testing confirmed the diagnosis of antenatal Bartter syndrome. The baby was in good clinical condition at the 3-month follow-up visit. Conclusions: For pregnant women with early onset and refractory severe polyhydramnios without morphological anomalies, antenatal Bartter syndrome should be highly suspected.
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Mrad FCC, Soares SBM, de Menezes Silva LAW, Dos Anjos Menezes PV, Simões-E-Silva AC. Bartter's syndrome: clinical findings, genetic causes and therapeutic approach. World J Pediatr 2021; 17:31-39. [PMID: 32488762 DOI: 10.1007/s12519-020-00370-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGOUND Bartter's syndrome (BS) is a rare group of salt losing tubulopathies due to the impairment of transport mechanisms at the thick ascending limb of the Henle's loop. DATA SOURCES Literature reviews and original research articles were collected from database, including PubMed and Scopus. RESULTS According to the time of onset and symptoms, BS can be classified into antenatal and classic BS. Molecular studies have identified different subtypes of BS. BS types I, II and III are caused by mutations on genes encoding the luminal Na+-K+-2Cl- co-transporter, the luminal K+ channel ROMK, and the basolateral chloride channel ClC-Kb (CLCNKB), respectively. Loss-of-function mutations of Barttin CLCNK type accessory beta subunit cause BS type IVa. Simultaneous mutations of CLCNKB and CLCNKA cause BS type IVb. BS type V consists in a novel transient form characterized by antenatal presentation due to mutations in the MAGE family member D2. Severe gain-of-function mutations of the extracellular calcium sensing receptor gene can result in an autosomal dominant condition of BS. Main clinical and biochemical alterations in BS include polyuria, dehydration, hypokalemia, hypochloremic metabolic alkalosis, hyperreninemia, high levels of prostaglandins, normal or low blood pressure, hypercalciuria and failure to thrive. Treatment focuses mainly at correcting dehydration and electrolyte disturbances and in measures to reduce polyuria, including the use of nonsteroidal anti-inflammatory medications to control excessive renal prostaglandin E2 production. CONCLUSIONS Early diagnosis and treatment of BS may prevent long-term consequences such as growth failure, nephrocalcinosis and end-stage renal disease.
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Affiliation(s)
- Flavia Cristina Carvalho Mrad
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Av. Prof. Alfredo Balena, 190, Room # 281, Belo Horizonte, MG 30130-100, Brazil.,Pediatric Nephrology Unit, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Sílvia Bouissou Morais Soares
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Av. Prof. Alfredo Balena, 190, Room # 281, Belo Horizonte, MG 30130-100, Brazil
| | - Luiz Alberto Wanderley de Menezes Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Av. Prof. Alfredo Balena, 190, Room # 281, Belo Horizonte, MG 30130-100, Brazil
| | - Pedro Versiani Dos Anjos Menezes
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Av. Prof. Alfredo Balena, 190, Room # 281, Belo Horizonte, MG 30130-100, Brazil
| | - Ana Cristina Simões-E-Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Av. Prof. Alfredo Balena, 190, Room # 281, Belo Horizonte, MG 30130-100, Brazil.
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Ponzoni L, Nguyen NH, Bahar I, Brodsky JL. Complementary computational and experimental evaluation of missense variants in the ROMK potassium channel. PLoS Comput Biol 2020; 16:e1007749. [PMID: 32251469 PMCID: PMC7162551 DOI: 10.1371/journal.pcbi.1007749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/16/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023] Open
Abstract
The renal outer medullary potassium (ROMK) channel is essential for potassium transport in the kidney, and its dysfunction is associated with a salt-wasting disorder known as Bartter syndrome. Despite its physiological significance, we lack a mechanistic understanding of the molecular defects in ROMK underlying most Bartter syndrome-associated mutations. To this end, we employed a ROMK-dependent yeast growth assay and tested single amino acid variants selected by a series of computational tools representative of different approaches to predict each variants’ pathogenicity. In one approach, we used in silico saturation mutagenesis, i.e. the scanning of all possible single amino acid substitutions at all sequence positions to estimate their impact on function, and then employed a new machine learning classifier known as Rhapsody. We also used two additional tools, EVmutation and Polyphen-2, which permitted us to make consensus predictions on the pathogenicity of single amino acid variants in ROMK. Experimental tests performed for selected mutants in different classes validated the vast majority of our predictions and provided insights into variants implicated in ROMK dysfunction. On a broader scope, our analysis suggests that consolidation of data from complementary computational approaches provides an improved and facile method to predict the severity of an amino acid substitution and may help accelerate the identification of disease-causing mutations in any protein. As the number of sequenced human genomes rises, a major challenge is to identify which single amino acid variations in a protein affect function and predispose individuals to disease. While predictive algorithms are available for this purpose, a comparative analysis of recently developed algorithms has not been adequately performed, nor is it clear whether combining algorithms would improve predictive power. To this end, we compared the efficacy of three publicly available algorithms and applied the results to Bartter syndrome, a human disease for which numerous poorly-characterized single amino acid variants have been identified and for which there is no cure. In silico saturation mutagenesis, i.e., the computational prediction of pathogenesis for every possible amino acid substitution, allowed us to experimentally test predictions by measuring the activity of an ion channel linked to Bartter syndrome. Based on data from blinded experiments, we discovered that Rhapsody and EVmutation successfully predicted deleterious mutations. Moreover, Rhapsody—which takes into account evolutionary as well as structural and dynamic considerations—predicted that >90% of known Bartter syndrome mutations are deleterious. Overall, our data will aid investigators who wish to test single amino acid variants in any protein and aid biomedical researchers who wish to develop hypotheses on the potential severity of genetic variants uncovered from genome databases.
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Affiliation(s)
- Luca Ponzoni
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nga H. Nguyen
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ivet Bahar
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (IB); (JLB)
| | - Jeffrey L. Brodsky
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (IB); (JLB)
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10
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Halperin D, Dolgin V, Geylis M, Drabkin M, Yogev Y, Wormser O, Schreiber R, Shalev H, Landau D, Birk OS. A novel SLC12A1 mutation in Bedouin kindred with antenatal Bartter syndrome type I. Ann Hum Genet 2019; 83:361-366. [PMID: 30977917 DOI: 10.1111/ahg.12317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/26/2019] [Indexed: 12/01/2022]
Abstract
Four affected individuals of consanguineous kindred presented at infancy with an apparently autosomal recessive syndrome of polyuria and hypokalemic metabolic alkalosis, following maternal polyhydramnios and premature delivery, culminating in severe failure to thrive. Hypercalciuria, nephrocalcinosis, and hyperaldosteronism were further apparent as well as an unusual finding of intermittent hypernatremia. Additionally, all patients demonstrated variable micrognathia with upper respiratory airway abnormalities. As neither postnatal hyperkalemia nor permanent hearing deficits were shown, clinical assessment was consistent with antenatal Bartter syndrome (ABS) type I, which was never described before in the Israeli Bedouin population. Through genome-wide linkage analysis, we identified a single ∼3.3 Mbp disease-associated locus on chromosome 15q21.1, segregating within the pedigree. Whole-exome sequencing revealed a single novel homozygous missense mutation within this locus, in SLC12A1, encoding the Na-K-Cl cotransporter, NKCC2, in accordance with the clinical diagnosis. In this concise study, we report a novel missense mutation within the SLC12A1 gene, causing a severe form of ABS type I, the first to be described in Israeli Bedouins, with unusual clinical features of hypernatremia caused by nephrogenic diabetes insipidus and putatively related micrognathia with upper airway abnormalities .
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Affiliation(s)
- Daniel Halperin
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vadim Dolgin
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Geylis
- Pediatric Nephrology Clinic, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Max Drabkin
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Yogev
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ohad Wormser
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruth Schreiber
- Pediatric Nephrology Clinic, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hanna Shalev
- Pediatric Nephrology Clinic, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Daniel Landau
- Pediatrics Department A, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatrics Department B, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ohad S Birk
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Genetics Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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11
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A Case Report on Bartter Syndrome as Urinary Tract Stone and Poor Weight Gain in a One-Year Old Child. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.86247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Abstract
Bartter and Gitelman syndromes are conditions characterized by renal salt-wasting. Clinical presentations range from severe antenatal disease to asymptomatic with incidental diagnosis. Hypokalemic hypochloremic metabolic alkalosis is the common feature. Bartter variants may be associated with polyuria and weakness. Gitelman syndrome is often subtle, and typically diagnosed later life with incidental hypokalemia and hypomagnesemia. Treatment may involve fluid and electrolyte replenishment, prostaglandin inhibition, and renin-angiotensin-aldosterone system axis disruption. Investigators have identified causative mutations but genotypic-phenotypic correlations are still being characterized. Collaborative registries will allow improved classification schema and development of effective treatments.
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Affiliation(s)
- Rosanna Fulchiero
- Department of Pediatrics, Inova Children's Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Patricia Seo-Mayer
- Department of Pediatrics, Inova Children's Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA; Division of Nephrology and Hypertension, Pediatric Specialists of Virginia, 3023 Hamaker Court, Suite 600, Fairfax, VA 22031, USA; Virginia Commonwealth School of Medicine, Richmond, VA, USA.
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13
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Shrim A, Yakubov R, Bronshtein M, Beloosesky R. A novel differential diagnosis to nonobstructive diffuse and dilated bowel loops with polyhydramnios: Bartter syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:42-43. [PMID: 30246465 DOI: 10.1002/jcu.22642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Alon Shrim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Renata Yakubov
- Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
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14
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Abstract
Bartter syndrome is an inherited renal tubular disorder caused by a defective salt reabsorption in the thick ascending limb of loop of Henle, resulting in salt wasting, hypokalemia, and metabolic alkalosis. Mutations of several genes encoding the transporters and channels involved in salt reabsorption in the thick ascending limb cause different types of Bartter syndrome. A poor phenotype-genotype relationship due to the interaction with other cotransporters and different degrees of compensation through alternative pathways is currently reported. However, phenotypic identification still remains the first step to guide the suspicion of Bartter syndrome. Given the rarity of the syndrome, and the lack of genetic characterization in most cases, limited clinical evidence for treatment is available and the therapy is based mainly on the comprehension of renal physiology and relies on the physician's personal experiences. A better understanding of the mutated channels and transporters could possibly generate targets for specific treatment in the future, also encompassing drugs aiming to correct deficiencies in folding or plasma membrane expression of the mutated proteins.
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Affiliation(s)
- Tamara da Silva Cunha
- Nephrology Division, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, Brazil,
| | - Ita Pfeferman Heilberg
- Nephrology Division, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, Brazil,
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15
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Abdelgadir IS, Elgharbawy F, Salameh KM, Juma BE. Antenatal Bartter syndrome presenting with vomiting and constipation mimicking subacute intestinal obstruction in a 20-day-old neonate. BMJ Case Rep 2017; 2017:bcr-2017-221062. [PMID: 29141924 PMCID: PMC5695498 DOI: 10.1136/bcr-2017-221062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/04/2022] Open
Abstract
Antenatal Bartter syndrome is a rare condition that can present with different clinical features. These features include early onset maternal polyhydramnios, failure to thrive, prematurity and nephrocalcinosis.We are presenting this 20-day-old girl who had an antenatal history of polyhydramnios. She developed persistent non-bilious vomiting that was associated with constipation soon after birth. She presented with failure to thrive and features suggestive of intestinal obstruction. On the initial evaluation, she was noted to have hypokalaemic, hyponatraemic metabolic alkalosis. The initial work-up was done to exclude surgical and renal causes of her presentation, and the diagnosis was confirmed by gene analysis to be type III-classic Bartter syndrome. She was closely monitored for her growth and development with the appropriate salt replacement therapy.
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16
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O'Donnell BM, Mackie TD, Brodsky JL. Linking chanelopathies with endoplasmic reticulum associated degradation. Channels (Austin) 2017; 11:499-501. [PMID: 28723237 DOI: 10.1080/19336950.2017.1357944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Brighid M O'Donnell
- a Department of Biological Sciences , University of Pittsburgh , Pittsburgh , PA , USA.,b Department of Medicine , University of Pittsburgh , Pittsburgh , PA , USA
| | - Timothy D Mackie
- a Department of Biological Sciences , University of Pittsburgh , Pittsburgh , PA , USA
| | - Jeffrey L Brodsky
- a Department of Biological Sciences , University of Pittsburgh , Pittsburgh , PA , USA
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17
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Qian M, Han SP, Yu ZB, Chen XH. [Poor weight gain, recurrent metabolic alkalosis and hypokalemia in a neonate]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:812-815. [PMID: 28697837 PMCID: PMC7389915 DOI: 10.7499/j.issn.1008-8830.2017.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/14/2017] [Indexed: 06/07/2023]
Abstract
The study reports a female neonate with a gestational age of 29+2 weeks and a birth weight of 1 210 g. Ten minutes after birth, the neonate was admitted to the hospital due to shortness of breath. Several days after birth, the neonate presented with hyperglycemia, polyuria, and poor weight gain, accompanied by azotemia, hypochloremic metabolic alkalosis, hypokalemia, and hyponatremia. Laboratory examinations showed elevated levels of aldosterone, renin, and angiotensin II. Gene detection revealed SLC12A1 gene mutation. Neonatal Bartter syndrome was thus confirmed. The neonate was treated with sodium and potassium supplements, and was followed up for 8 months. During the follow-up, the mental and neural development of the neonate was almost normal at the corrected age, and regular reexaminations showed slight metabolic alkalosis and almost normal electrolyte levels. For the neonates who have the symptoms of unexplainable polyurine and electrolyte disorders, it is important to examine the levels of aldosterone, renin and angiotensin. A definite diagnosis of neonatal Bartter syndrome can be made based on the presence of SLC12A1 gene mutation.
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Affiliation(s)
- Miao Qian
- Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China.
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18
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Raina R, Chaturvedi T, Polaconda S, Siri Mukunda A, Kumar Sethi S, Krishnappa V. A unique finding of normal aldosterone level in Bartter’s syndrome. J Nephropathol 2017. [DOI: 10.15171/jnp.2017.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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19
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Sun M, Ning J, Xu W, Zhang H, Zhao K, Li W, Li G, Li S. Genetic heterogeneity in patients with Bartter syndrome type 1. Mol Med Rep 2016; 15:581-590. [PMID: 28000888 PMCID: PMC5364841 DOI: 10.3892/mmr.2016.6063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
Abstract
Bartter syndrome (BS) type 1 is an autosomal recessive kidney disorder caused by loss-of-function mutations in the solute carrier family 12 member 1 (SLC12A1) gene. To date, 72 BS type 1 patients harboring SLC12A1 mutations have been documented. Of these 144 alleles studied, 68 different disease-causing mutations have been detected in 129 alleles, and no mutation was detected in the remaining 15 alleles. The mutation types included missense/nonsense mutations, splicing mutations and small insertions and deletions ranging from 1 to 4 nucleotides. A large deletion encompassing a whole exon in the SLC12A1 gene has not yet been reported. The current study initially identified an undocumented homozygous frameshift mutation (c.1833delT) by Sanger sequencing analysis of a single infant with BS type 1. However, in a subsequent analysis, the mutation was detected only in the father's DNA. Upon further investigation using a next-generation sequencing approach, a deletion in exons 14 and 15 in both the patient and patient's mother was detected. The deletion was subsequently confirmed by use of a long-range polymerase chain reaction and was determined to be 3.16 kb in size based on sequencing of the junction fragment. The results of the present study demonstrated that pathogenic variants of SLC12A1 are heterogeneous. Large deletions appear to serve an etiological role in BS type 1, and may be more prevalent than previously thought.
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Affiliation(s)
- Mingran Sun
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Jing Ning
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Weihong Xu
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Han Zhang
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Kaishu Zhao
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Wenfu Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
| | - Guiying Li
- Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun, Jilin 130012, P.R. China
| | - Shibo Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK 73117, USA
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20
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Özdemir ÖM, Çıralı C, Yılmaz Ağladıoğlu S, Evrengül H, Tepeli E, Ergin H. Neonatal Bartter syndrome with cholelithiasis and hydrocephalus: Rare association. Pediatr Int 2016; 58:912-5. [PMID: 27682612 DOI: 10.1111/ped.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/10/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
Neonatal Bartter syndrome (NBS) is a rare autosomal recessive renal tubular disorder. This disease is characterized by hypokalemia, hypochloremia, and metabolic alkalosis that is often associated with failure to thrive and recurrent episodes of dehydration. The combination of BS and cholelithiasis in an infant is very rare. Herein, we report a premature male infant with NBS who developed cholelithiasis and hydrocephalus on clinical follow up. We recommend that periodic routine hepatobiliary ultrasonograpic screening for cholelithiasis should be performed in patients with NBS.
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Affiliation(s)
- Özmert Ma Özdemir
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ceren Çıralı
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Sebahat Yılmaz Ağladıoğlu
- Department of Pediatric Endocrinology, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Havva Evrengül
- Department of Pediatric Nephrology, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Emre Tepeli
- Department of Genetics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Hacer Ergin
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Turkey.
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21
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Rachid ML, Dreux S, Czerkiewicz I, Deschênes G, Vargas‐Poussou R, Mahieu‐Caputo D, Oury J, Muller F. Fetal urine biochemistry in antenatal Bartter syndrome: a case report. Clin Case Rep 2016; 4:876-8. [PMID: 27648267 PMCID: PMC5018593 DOI: 10.1002/ccr3.471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/09/2015] [Accepted: 11/05/2015] [Indexed: 11/19/2022] Open
Abstract
Bartter syndrome is a severe inherited tubulopathy responsible for renal salt wasting, and hence electrolyte disorders and dehydration. Prenatally, it is characterized by severe polyhydramnios caused by fetal polyuria. We studied for the first time fetal urine in a Bartter syndrome case and demonstrated that the tubulopathy is already present at 24 weeks of gestation.
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Affiliation(s)
| | - Sophie Dreux
- Biochimie‐HormonologieHôpital Robert DebréAPHPParisFrance
| | | | | | | | | | | | - Françoise Muller
- Biochimie‐HormonologieHôpital Robert DebréAPHPParisFrance
- Université Versailles Saint Quentin en YvelinesVersaillesFrance
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22
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Bernardo Vega R, Lobo Valentin R, Martin Medrano E, González Blanco I, Arnal Burro A, Vázquez Camino F. Síndrome de Bartter como causa de polihidramnios severo. A propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Cha EJ, Hwang WM, Yun SR, Park MH. An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria. J Pathol Transl Med 2016; 50:160-4. [PMID: 26755355 PMCID: PMC4804144 DOI: 10.4132/jptm.2015.08.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022] Open
Abstract
Bartter syndrome (BS) I–IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.
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Affiliation(s)
- Eun Jung Cha
- Department of Pathology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Won Min Hwang
- Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sung-Ro Yun
- Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Moon Hyang Park
- Department of Pathology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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24
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Bernardo Vega R, Lobo Valentin R, Martin Medrano E, González Blanco I, Arias Valdés E, Vázquez Camino F. Síndrome de Bartter como causa de polihidramnios severo. A propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Rachid ML, Dreux S, Pean de Ponfilly G, Vargas-Poussou R, Czerkiewicz I, Chevenne D, Oury JF, Deschênes G, Muller F. Prenatal diagnosis of Bartter syndrome: amniotic fluid aldosterone. Prenat Diagn 2015; 36:88-91. [PMID: 26528764 DOI: 10.1002/pd.4717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Bartter syndrome is a severe inherited tubulopathy characterized by postnatal salt wasting, severe polyuria, dehydration, failure to thrive and secondary hyperaldosteronism. Prenatally, the disease is usually discovered following the onset of severe polyhydramnios in the second trimester. We studied amniotic fluid aldosterone concentration in Bartter syndrome and in controls. METHODS Amniotic fluid aldosterone was assayed by radioimmunoassay. We undertook a retrospective case-control study based on 36 cases of prenatally suspected and postnatally confirmed Bartter syndrome (22 with identified mutations): and 72 gestational age matched controls presenting with polyhydramnios and 72 without polyhydramnios. Amniotic fluid aldosterone was compared between the three groups. RESULTS The median amniotic fluid aldosterone concentration in the Bartter syndrome group (90 pg/mL) was not different from that in the controls with polyhydramnios (90 pg/mL, P = 0.33) or without polyhydramnios (87 pg/mL, P = 0.41). CONCLUSION Amniotic fluid aldosterone assay cannot be used for prenatal diagnosis of Bartter syndrome. © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Myriam L Rachid
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | | | - Rosa Vargas-Poussou
- Département de Génétique, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | - Didier Chevenne
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | | | | | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France.,Université Versailles Saint Quentin en Yvelines, Paris, France
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26
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Park MG, Lim TW, Oh HT, Song SU, Heo D, Rim H. A Case of Adult onset Bartter Syndrome with Nephrocalcinosis. KOSIN MEDICAL JOURNAL 2014. [DOI: 10.7180/kmj.2014.29.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism, normal blood pressure, and other clinical symptoms. As a clinical and genetical heterogeneous disorder, this syndrome can be classified into two clinical variants, antenatal Bartter syndrome and classic Bartter syndrome according to the onset age. Nephrocalcinosis is common in antenatal Bartter syndrome, but is rare in classic Bartter syndrome. It can also be classified into five genetic subtypes by the underlying mutant gene, all of which are expressed in the tubular epithelial cells of the thick ascending limb of the loop of Henle. Patients with Bartter syndrome type 1, 2 and 4 present at a younger age than classic Bartter syndrome type 3. We have experienced a case of Bartter syndrome with nephrocalcinosis in a 42-year-old woman diagnosed by biochemical and radiologic studies. We had successful response with potassium chloride and spironolactone.
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27
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Preshaw J, Pillai M. Severe early onset hydramnios in a singleton pregnancy due to antenatal Bartter syndrome. J OBSTET GYNAECOL 2014; 34:274-5. [PMID: 24483758 DOI: 10.3109/01443615.2013.851658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J Preshaw
- Women's Centre, Gloucestershire Royal Hospital , Gloucester , UK
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28
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Flores FX, Ojeda FJ, Calhoun DA. Bartter syndrome: presentation in an extremely premature neonate. J Perinatol 2013; 33:661-2. [PMID: 23897314 DOI: 10.1038/jp.2013.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/22/2012] [Indexed: 11/09/2022]
Abstract
Reports of Bartter syndrome in premature neonates are rare. We describe the presentation and clinical course of a neonate born at 25.6 weeks estimated gestational age with polyuria, hyponatremia, hypokalemia and hypercalciuria ,who was diagnosed with neonatal Bartter syndrome. The evaluation, diagnosis and management of neonatal Bartter syndrome in this premature neonate are discussed.
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Affiliation(s)
- F X Flores
- Pediatric Nephrology, University of South Florida, Morsani College of Medicine, All Children's Hospital, Division of Nephrology, St. Petersburg, FL, USA
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29
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Sakallı H, Bucak Hİ. Type IV neonatal Bartter syndrome complicated with congenital chloride diarrhea. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:230-3. [PMID: 23569535 PMCID: PMC3616172 DOI: 10.12659/ajcr.883446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/20/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pseudo-Bartter syndrome encompasses a heterogenous group of disorders similar to Bartter syndrome. Sometimes a few status may be nested, as in our case presented here. CASE REPORT An 8-month-old boy was referred to our hospital with of intractable diarrhea, polyuria, persistent hypokalemia, abdominal distension and failure to thrive. He was born in the 34 6/7 gestational week (GW) to consanguineous parents. In the 30(th) GW polyhydramnios was verified by ultrasonography. The laboratory results showed hypokalemic-hypochloremic metabolic alkalosis, hyponatremia, and increased urinary loss of chloride, potassium and calcium. An audiogram test revealed complete sensorineural deafness. Ultrasonography revealed medullary nephrocalcinosis in both kidneys. Elevated plasma renin activity and aldosterone were found and a provisional diagnosis of type-IV neonatal Bartter syndrome was made. Treatment with indomethacin, spironolactone and additional intake of NaCl/KCl was initiated. Despite these therapies, the child's diarrhea persisted but serum potassium concentration normalized, and hypercalciuria and urine output reduced. After determining the high fecal chloride concentration, there was an immediate decompensation of the disease on indomethacin withdrawal, thus a diagnosis of type IV neonatal Bartter syndrome complicated with congenital chloride diarrhea was considered. Indomethacin, spironolactone and supplementary therapies with NaCl/KCl were continued, which resulted in the normalization of serum electrolytes as well as his physical development, but high contents of chloride in urine and faeces and nephrocalcinosis remains unchanged during 1-year follow-up. CONCLUSIONS Because of the clinical and laboratory simulations between the various diseases that lead to hypokalemic-hypochloremic metabolic alkalosis, patients must be evaluated carefully.
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Affiliation(s)
- Hale Sakallı
- Department of Pediatric Nephrology, Numune Teaching and Research Hospital, Adana, Turkey
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