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Nasir N, Mohanty D, Pande AK, Khanna D, Vishvakarma K, Gupta L. Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism. Rheumatol Int 2023; 43:567-574. [PMID: 34800134 DOI: 10.1007/s00296-021-05042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022]
Abstract
We describe an unusual clinical presentation of autoimmune Bartter syndrome in a patient with primary hypothyroidism. A 65-year-old female patient was admitted with neuromuscular weakness associated with hypokalemia and metabolic alkalosis. She had a suboptimal response to potassium supplementation and potassium-sparing diuretic resulting in re-hospitalization with the same symptoms. A detailed serum and urinary biochemistry analysis in the absence of other causes of potassium wasting helped diagnose Bartter syndrome, a rare entity in adults. An autoimmune profile showed anti-Scl-70 antibody to be positive, although she did not develop other systemic features of the disease. Our patient responded to a steroid-based regimen potassium supplement, Indomethacin, and aldosterone antagonist with remarkable resolution of symptoms and correction of electrolyte derangement. We reviewed the literature to search for similar cases and included twenty-seven full-length publications on acquired and autoimmune causes of Bartter syndrome. Our case highlights the fact that hypokalemia with metabolic alkalosis in an adult patient should prompt clinicians to evaluate for common and uncommon conditions. While assessing for abnormal conditions, acquired Bartter syndrome should be considered if a patient has an underlying autoimmune, endocrine, or connective tissue disease.
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Affiliation(s)
- Noreen Nasir
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Arun Kumar Pande
- Department of Endocrinology, Sahara Hospital, Lucknow, India.
- Lucknow Endocrine and Diabetes Clinic, Lucknow, India.
| | - Dhanita Khanna
- Department of Rheumatology, Sahara Hospital, Lucknow, India
| | | | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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He Y, Zhou Y, Wu W, Chen Y, Ou S. Bartter syndrome with multiple renal and liver cysts: a case report. Int Urol Nephrol 2023; 55:225-228. [PMID: 35768702 DOI: 10.1007/s11255-022-03274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Yemei He
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Yue Zhou
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, China
| | - Weihua Wu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China. .,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China. .,Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, China.
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China. .,Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China.
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Saleem N, Nasir H, Hassan D, Manzoor M. Association of Adult-Onset Bartter Syndrome With Undifferentiated Connective Tissue Disorder. Cureus 2021; 13:e17140. [PMID: 34532176 PMCID: PMC8435068 DOI: 10.7759/cureus.17140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
Bartter syndrome is a rare autosomal recessive, salt-losing disorder characterized by hypokalemic hypochloremic metabolic alkalosis. We are reporting a case of 21 years old patient, who presented with lower limb weakness, marked hypokalemia, proteinuria, and renal impairment detected on laboratory evaluation. The diagnosis of Bartter syndrome was suspected by marked hypokalemia and was supported by renal biopsy which showed evidence of Juxtaglomerular (JG) hyperplasia. This is the first case report about clinicopathological features of the patient with acquired Bartter syndrome and associated undifferentiated connective tissue disorder manifesting as hypokalemia with paralysis.
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Affiliation(s)
- Nida Saleem
- Internal Medicine/Nephrology, Shifa International Hospital, Islamabad, PAK
| | - Humaira Nasir
- Histopathology, Shifa International Hospital, Islamabad, PAK
| | - Danyal Hassan
- Internal Medicine/Nephrology, Shifa International Hospital, Islamabad, PAK
| | - Momena Manzoor
- internal Medicine/Nephrology, Shifa International Hospital, Islamabad, PAK
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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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Li Y, Wu C, Gu J, Li D, Yang Y. A novel mutation associated with Type III Bartter syndrome: A report of five cases. Mol Med Rep 2019; 20:65-72. [PMID: 31115572 DOI: 10.3892/mmr.2019.10255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/06/2019] [Indexed: 11/05/2022] Open
Abstract
The clinical, biochemical and mutation spectra of Chinese patients with Type III Bartter syndrome (type III BS), a rare autosomal recessive disorder, were investigated. A total of five unrelated Chinese patients aged 8 months to 24 years were diagnosed with type III BS via analysis of biochemical markers, including chloride, potassium and calcium, and genetic sequencing. The levels of insulin‑like growth factor‑1 (IGF‑1) were evaluated via ELISA and a mutation study of cultured amniocytes was conducted for prenatal diagnosis. The child patients were admitted for polydipsia, polyuria, myasthenia and developmental delay, whereas the adult patients were hospitalized for limb numbness, polydipsia and polyuria. Nine variants in the chloride voltage‑gated channel Kb (CLCNKB) gene were detected, including eight sequence variants and one whole CLCNKB gene deletion. One sequence variant (c.1967T>C) was novel, whereas the remaining variants (c.595G>T, c.908A>C, c.1004T>C, c.1312C>T, c.1334_1335delCT and c.1718C>A) and the whole gene deletion had been previously reported. The whole gene deletion was frequently observed in patients with early‑onset type III BS in the present study. Two patients showed IGF‑1 deficiency with normal growth hormone level. All patients were treated with potassium supplementation and indometacin. The mother of one patient underwent amniocentesis during her second pregnancy; the fetus was not affected by type III BS based on screening for sequence variants, and normal development and blood electrolyte analysis following birth confirmed the diagnosis. In conclusion, five cases of type III BS in patients from mainland China were reported. Large deletions were frequently detected, particularly in early‑onset patients; isolated IGF‑1 deficiency was found, one novel sequence variant was identified. Prenatal diagnosis was successfully established using genetic analysis of cultured amniocytes, and may facilitate the prevention of congenital defect of type III BS in the next pregnancy.
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Affiliation(s)
- Yanhan Li
- Department of Laboratory Animal Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, P.R. China
| | - Chengcheng Wu
- Department of Cardiology, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Jie Gu
- Department of Laboratory Animal Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, P.R. China
| | - Dong Li
- Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, P.R. China
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Abstract
PURPOSE OF REVIEW Antenatal Bartter syndrome (aBS) is a heterogenous disease resulting from defective ion transport in the thick ascending limb of the loop of Henle. Novel insights into the pathophysiology, as well as the recent identification of a novel genetic cause of aBS, merit an update on this topic. RECENT FINDINGS In aBS, severe salt losing is further aggravated by defective salt sensing in the macula densa, where a reduced tubular salt concentration is perceived and glomerular filtration is increased instead of decreased. As patients with aBS come of age, there is an increased incidence of proteinuria and impaired renal function.Moreover, we recently reported a new form of aBS. Indeed, we described a series of nine families in whom pregnancies with male fetuses where complicated by acute polyhydramnios, preterm delivery and with severe but transient polyuria. We identified mutations in melanoma-associated antigen D2 in all study participants and showed, in vivo and in vitro, reduced expression of the furosemide and thiazide sensitive transporters sodium-potassium-2-chloride cotransporter and sodium chloride cotransporter, respectively. SUMMARY Genetic studies revealed the complexity of ion transport in the thick ascending limb of the loop of Henle and will help to clarify the pathophysiology, which is essential to design new therapies.
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