Summary
Four females (27–54 y), presenting with a history of long-term laxative abuse, were admitted to the Medizinische Poliklinik for evaluation of generalized weakness. Laboratory findings revealed signs of Bartter's syndrome, including hypokalemia, systemic alkalosis and normal blood pressure. Three of the four females showed impaired renal function and elevated serum uric acid levels, two of them suffered from recurrent gouty attacks.
In our patients the incidence of hyperuricemia and impaired renal function, as a consequence of chronic hypokalemia, was much higher than known from patients with Bartter's syndrome. Hyperuricemia is related to some pathophysiological features of Pseudo-Bartter's syndrome, (e.g. systemic alkalosis, elevated angiotensin) and combined with additional factors (e.g. catabolism, reduced plasma volume) may lead to gouty attacks. Gallstones were found in two of the four females. Long term surreptitious laxative ingestion frequently is observed in females. Hypokalemia, induced by the laxatives, causes reduced intestinal motility and leads to augmented laxative intake. These patients are prone to develop Pseudo-Bartter's syndrome, causing eventually a hyperuricemia and gouty attacks.
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Literatur
Arisz L, Danker AJ, Brentjens JR, van der Hem GK (1976) The effect of indomethacin on proteinuria and kidney function in the nephrotic syndrom. Acta Med Scand 199:121–125
Baehler RW, Work J, Kotchen TA, Mc Morrow G, Guthrie G (1980) Studies on the pathogenesis of Bartter's syndrome. Am J Med 69:933–938
Bank N, Aynedjian HS (1964) A micropunture study of the renal concentrating defect of potassium depletion. Am J Physiol 206:1347–1354
Bartter FC, Pronove P, Gill JR Jr, Mac Cardle RC (1980) Hyperplasia of the juxtaglomerular complex with hyperaldosteronism and hypokalemic alkalosis. Am J Med 33:811–828
Bartter FC (1980) On the pathogenesis of Bartter's syndrome. Min Electrol Metab 3:61–65
Bennet CM (1970) Urine concentration and dilution in hypokalemic and hypercalcemic dogs. J Clin Invest 49:1447–11457
Burg M, Stoner L, Cardinal J, Green N (1973) Furosemide effect on isolated perfused tubules. Am J Physiol 225:119
Burg M, Green N (1973) Effect of ethacrynic acid on the thick ascending limb of Henle's loop. Kidney Int 4:301–308
Donker AJM, de Jong PE, Statius van Eps LW, Brentjens JRH, Bakker K, Doorenbos H (1977) Indomethacin in Bartter's syndrome. Nephron 19:200–213
Fichman MP, Telfer N, Zia P et al. (1976) Role of prostaglandins in the pathogenesis of Bartter's syndrome. Am J Med 60:785–798
Fleischer N, Brown H, Graham DY, Delena S (1968) Chronic laxative-induced hyperaldosteronism and hypokalemia simulating Bartter's syndrome. Ann Int Med 70:791–798
Gill JR, Frölich JC, Boweden RE et al. (1976) Bartter's syndrome: a disorder characterized by high urinary prostaglandins and a dependence of hyperreninemia on prostaglandin synthesis. Am J Med 61:43–51
Goodman AD, Vagnucci AH, Hartroft PM (1969) Pathogenesis of Bartter's syndrome. N Engl J Med 281:1435–1439
Greven J (1986) Die Bedeutung des Tamm-Horsfall-Proteins für die tubuläre Wirkung der Schleifendiuretika. In: Krück F, Schrey A (Hrsg) Diuretika III, 3. Diuretika-Symposium, Konstanz 1985. Springer, Heidelberg, pp 27–29
Güllner HG, Cerletti C, Bartter FC, Smith JB, Gill JR (1979) Prostacyclin overproduction in Bartter's syndrome. Lancet II:767–768
Hayslett JP, Binder HJ (1982) Mechanisms of potassium adaption. Am J Physiol 243:F103-F112
Hollander W Jr, Winter RW, Williams TF, Bradley F, Oliver J, Welt LG (1957) Defect in the tubular reabsorption of water associated with potassium depletion in rats. Am J Physiol 189:557–563
James T (1976) Bartter's syndrome, editorial. JAMA 235:1966
Jamison RL, Ross JC, Kempson RL, Sufit CR, Parker TE (1982) Surreptitious diuretic ingestion and Pseudo-Bartter's syndrome. Am J Med 73:142–147
Kennedy BJ (1978) Bartter's syndrome — limelight on prostaglandins. JAMA 239:137–138
Kimberly RP, Gill JR, Brown RE, Keiser HR, Platz PH (1978) Elevated urinary prostaglandins and the effects of aspirin on renal function in lupus erythematosus. Ann Int Med 89:336–341
Kurtzman NA, Gutierrez LF (1975) The pathophysiology of Bartter's syndrome. JAMA 234:758–759
Marver D (1984) Assessment of mineralocorticoid activity in the rabbit colon. Am J Physiol 246:F437-F446
Meyer WJ, Gill JR, Bartter FC (1975) Gout as a complication of Bartter's syndrome. Ann Int Med 83:56–59
Rastegar A, Thier SO (1972) The physiologic approach to hyperuricemia. N Engl J Med 286:470–476
Richet G, Mignon F, Ardaillon R (1965) Goutte secondaire des nephropathies chroniques. Press Med 73:633–638
Relman AS, Schwartz WB (1956) The nephropathy of potassium depletion: a clinical and pathological entity. N Engl J Med 255:195–203
Sarre H (1964) Goutte secondaire à l'insuffisance renale. In: Travaux de Congrès International de la Goutte et de la Lithiase Urique. Evian, Paris, 245–255
Sorensen LB (1980) Gout secondary to chronic renal disease: Studies on urate metabolism. Ann Rheum Dis 39:424–430
Schwarz HA, Weidmann P, Messerli FH, Zia PK, Flammer J, Reubi FC (1977) Erhöhte renale Prostaglandin-E2-Sekretion bei Bartter-Syndrom. Schweiz Med Wschr 107:1870–1872
Steele TH, Rieselbach RE (1967) The contribution of residual nephrons within the chronically diseased kidney to urate homeostasis in man. Am J Med 43:876–886
Stein JH (1985) The pathogenetic spectrum of Bartter's syndrome. Kidney Int 28:85–93
Tomko DJ, Yeh BPY, Falls WF (1976) Bartter's syndrome: Study of a 52-year old man with evidence for a defect in proximal tubular sodium reabsorption and comments on therapy. Am J Med 61:111–117
Veldhuis JD, Bardin CW, Demers LM (1979) Metabolic mimicry of Bartter's syndrome by covert vomiting. Am J Med 66:361–363
Verberkmoes R, van Damme B, Clement J, Amery A, Michielsen P (1976) Bartter's syndrome with hyperplasia of reno-medullary cells: successfull treatment with indomethacin. Kidney Int 9:302–307
White MG (1972) Bartter's syndrome. Arch Intern Med 129:41–47
Zipser RD, Rude RK, Zia PK, Fichman MP (1979) Regulation of urinary prostaglandins in Bartter's syndrome. Am J Med 67:263
Zöllner N, Gröbner W (1976) Die Gichtniere. In: Schwiegk H (Hrsg) Handbuch der Inneren Medizin Band 7/III, 5. Auflage, Springer, Berlin Heidelberg New York, S 356–390
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Adam, O., Goebel, F.D. Sekundäre Gicht und Pseudo-Bartter-Syndrom bei Frauen mit Laxantienabusus. Klin Wochenschr 65, 833–839 (1987). https://doi.org/10.1007/BF01727480
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DOI: https://doi.org/10.1007/BF01727480