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2.1
Bartter Syndrome
Bartter's Disease

Presentation

Out of 11 cases, 6 (54.54%) patients in PBS group presented with features consistent with PBS leading to CF diagnosis labeled as “early presenters”. [cysticfibrosisjournal.com]

Paediatricians should be alerted with the variability in its presentation. [casereports.bmj.com]

CF could be presented as PBS, mainly in patients younger than 2 years. [elsevier.es]

Classic and neonatal Bartter syndrome have similar presenting symptoms but different presentation ages, Gitelman syndrome is found in late childhood or adolescence and has the classic hallmark finding of hypomagnesaemia, which differentiates it from classic [emro.who.int]

However, the major source of EPO synthesis in the kidney is presently known to be the interstitial fibroblasts and not the juxtaglomerular apparatus. Besides, EPO levels showed to be within normal range in the present case. [scielo.br]

Entire Body System

  • Fatigue

    Bartter described this syndrome in two African-American patients: a 5 year old boy and a 25 year old man with a long history of slow growth, weakness and fatigue. [flipper.diff.org]

    Manifestations vary depending on genotype, but growth and development may be affected and electrolyte abnormalities may cause muscle weakness, cramping, spasms, tetany, or fatigue. [merckmanuals.com]

    Also known as salt-wasting nephropathy, Bartter syndrome is characterized by dehydration, fatigue, cramping, weakness, brittle bones, and hardening of the kidneys (glomerulosclerosis). [verywellhealth.com]

    Bartter syndrome is also characterized by low levels of potassium in the blood (hypokalemia), which can result in muscle weakness, cramping, and fatigue. [encyclopedia.pub]

  • Weight Loss

    In our patient, the hyponatremia was chronic, as our patient presented with months of fatigue, weight loss and neurological manifestations. [scitechnol.com]

    Following birth, neonate should be monitored for urine output, hydration, weight loss, and electrolyte balance. Correction of dehydration and electrolyte imbalance are the important aspects of management. [hindawi.com]

    Maximum weight loss was 18% of the birth weight at D4 and birth weight was regained at D20. He presented hypochloremia, hyponatraemia, hyperkalemia up to D7, metabolic alkalosis after the first week of life and hypokalemia since D32 ( Table I ). [scielo.mec.pt]

    Neonates suspect for Bartter syndrome should be monitored closely for urine output, hydration status, weight loss and electrolyte balance. The characteristic electrolyte abnormalities include hypokalemia and metabolic alkalosis. [nature.com]

  • Short Stature in Children

    Children's growth rates may be slower than predicted for their age and gender as they get older (growth retardation). If left untreated, impacted people may grow up to be shorter than they would have been as adults (short stature). [news-medical.net]

    Growth delays and growth retardation may be seen as affected children age, and final adult height may be shorter than would otherwise be expected (short stature). [rarediseases.org]

  • Pediatric Disease

    The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. [dergipark.org.tr]

Gastrointestinal

  • Failure to Thrive

    Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]

    Failure to thrive in an infant has multiple etiologies and at times is the only manifestation of underlying serious diseases such as Bartter syndrome, in which the majority of patients present with failure to thrive, vomiting and constipation during the [emro.who.int]

    Principal clinical features in most of them include early onset polyhydramnios, failure to thrive, prematurity, and nephrocalcinosis. [hindawi.com]

    Reddy, “An Unusual Cause of Failure to Thrive in a Child,” The National Medical Journal of India, Vol. 24, No. 2, 2011, pp. 86-87. [7] P. S. Kumar, M. Deendayalan, L. Janakiraman and M. [scirp.org]

  • Polydipsia

    Main manifestations of BS with neonatal age: vomiting, diarrhoea, polyuria, polydipsia, signs of dehydration, with infants: hypocalcemic convulsions, paresis hypokalemic. [adc.bmj.com]

    Renal and metabolic studies were performed on a 4-year-old Negro girl with dwarfism, polyuria, polydipsia, salt craving, hyposthenuria, and hypokalemic alkalosis. [jamanetwork.com]

    […] cells along with: hypokalemia metabolic alkalosis hypotension/normotension elevated plasma renin elevated aldosterone antenatal polyhydramnios Classification There are two subtypes of Bartter syndrome: classic: presents in early childhood with polyuria, polydipsia [radiopaedia.org]

    He also complained muscular cramps, polydipsia and polyuria that began a few months before. The physical examination showed an anxious patient, hemodinamically stable, with normal cardiac, pulmonar and neurologic exam. [ejinme.com]

    Newborns with Bartter syndrome typically urinate excessively (polyuria), show signs of excessive thirst (polydipsia), and experience vomiting and diarrhea. [verywellhealth.com]

Ears

  • Hearing Impairment

    DISCUSSION Although the finding of mild hypophosphatemia and elevated serum intact PTH could have initially suggested the presence of some disorder of phosphate metabolism in the present case, the association of hypokalemia and hearing impairment, even [scielo.br]

    Abnormal changes in these genes impair these abilities, allowing for the loss of excess salt through the urine and also affecting the reabsorption of other things including potassium and calcium. [rarediseases.info.nih.gov]

Musculoskeletal

  • Muscle Weakness

    Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]

    Low blood levels of potassium can cause muscle weakness, cramping, and fatigue. Diagnosis and Treatment For children with symptoms of classic Bartter syndrome, a doctor will do a thorough exam along with blood and urine tests. [webmd.com]

    At each visit complaints related to hypokalemia (fatigue, muscle weakness, constipation, cardiac arrhythmias) and hypomagnesemia (tetany, cramps, paresthesias, joint and muscle pain) should be evaluated. [ukkidney.org]

  • Muscle Cramp

    When to Contact a Medical Professional Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently Images References Dixon BP. Inherited tubular transport abnormalities: Bartter syndrome. [ufhealth.org]

    When to Contact a Medical Professional Contact your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently References Dixon BP. Inherited tubular transport abnormalities: Bartter syndrome. [mountsinai.org]

    Calling your health care provider Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently [coordinatedhealth.com]

    When to Contact a Medical Professional Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently visHeader References Chan JC, Santos F, Hand M. [nicklauschildrens.org]

    Call your health care provider if your child is: Having muscle cramps Not growing well Urinating frequently Potassium wasting; Salt-wasting nephropathy Guay-Woodford LM. Hereditary nephropathies and developmental abnormalities of the urinary tract. [medlineplus.gov]

  • Proximal Muscle Weakness

    Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]

  • Carpopedal Spasm

    Other symptoms Other symptoms, which appear during late childhood, include fatigue, muscle weakness, cramps, and recurrent carpopedal spasms.  Developmental delay and minimal brain dysfunction with nonspecific electroencephalographic changes are also [slideshare.net]

  • Trousseau Sign

    In addition, some affected patients may have neuromuscular irritability as manifested by a positive Chvostek +/or Trousseau sign or frank tetany due to alkalosis and hypomagnesemia. [madeasy.de]

Neurologic

  • Lethargy

    The commonest are lethargy, transient weakness and/or tetany, paresthesiae, thirst and joint pains due to chondrocalcinosis. Blood pressure is usually lower than normal. Sudden cardiac arrest may occur. [ukkidney.org]

    Case report A 14-week-old boy presented with lethargy, poor oral intake and polyuria. There was no history of fever, vomiting or diarrhoea, although he had been previously admitted for dehydration without apparent cause. [emro.who.int]

    Constipation, vomiting, a raised body temperature, lethargy, and an overall sensation of ill health are all possible side effects. Children's growth rates may be slower than predicted for their age and gender as they get older (growth retardation). [news-medical.net]

    Poor feeding and lethargy are the other symptoms. Urine examination shows low specific gravity, normal potassium but high sodium and chloride levels. [hindawi.com]

    Individuals with BS type 3 may present antenatally with polyhydramnios, during infancy with failure to thrive and lethargy, or in adolescence or adulthood with symptoms of chronic hypokalemia, such as constipation, muscle cramps, salt-craving, nocturia [mayocliniclabs.com]

  • Asthenia

    CASE REPORT A deaf male patient was referred to the Nephrology unit for the first time at the age of 20 years due to asthenia and severe hypokalemia (potassium − K of 2.0mEq/L; normal range: 3.5 to 5.0mEq/L), accompanied by erythrocytosis (hemoglobin [scielo.br]

Urogenital

  • Polyuria

    Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]

    Prenatal manifestations, mainly recurrent polyhydramnios because of fetal polyuria, lead to premature delivery. After birth, polyuria leads to life-threatening dehydration. Prenatal genetic diagnosis needs an index case. [ncbi.nlm.nih.gov]

    The typical features include fetal polyuria, early onset maternal polyhydramnios, intrauterine growth restriction, preterm birth, postnatal polyuria, episodes of dehydration, recurrent vomiting, and failure to thrive [3, 4]. [hindawi.com]

    After birth he displayed extreme polyuria, severe renal sodium and chloride loss, and marked hypercalciuria. Five weeks after birth, his sodium chloride loss turned into renal potassium loss, along with a marked decrease in urine output. [link.springer.com]

  • Kidney Failure

    We may also use ultrasound imaging to look for calcium deposits in your child's kidneys. It is very unusual for Bartter syndrome to cause severe kidney failure, but in those rare cases, we treat the kidney failure as needed. [childrenscolorado.org]

    Infants who have severe growth failure may grow normally with treatment. Although most patients remain well with ongoing treatment, some develop kidney failure. Complications Kidney failure is a possible complication. [coordinatedhealth.com]

    Kidney function is also normal if the disease is treated,[4] but occasionally patients proceed to end-stage kidney failure. [en.wikipedia.org]

    Possible Complications Kidney failure or gallstones is a possible complication. [nicklauschildrens.org]

    Outlook (Prognosis) Infants who have severe growth failure may grow normally with treatment. Over time, some people with the condition will develop kidney failure. [ufhealth.org]

  • Nocturia

    Clinical findings Proximal muscle weakness, failure to thrive, short stature, convulsions, tetany, cramps, ileus, gout, mental retardation, enuresis, nocturia, polyuria, salt craving, constipation, insensitivity to angiotensin II pressor effects, normal [medical-dictionary.thefreedictionary.com]

    Symptoms Symptoms of Bartter syndrome may include: generalized weakness and fatigue increased urination (polyuria) increased thirst (polydipsia) waking up at night to urinate (nocturia) mild dehydration craving salt muscle cramping constipation Children [verywell.com]

    Polydipsia (excessive thirst), polyuria (excessive urine), and the need to urinate at night (nocturia) are possible symptoms. Despite drinking enough water, frequent urinating can cause dehydration. [news-medical.net]

    Among the characteristic symptoms of Bartter syndrome: The excessive loss of salt can lead to dehydration, constipation, salt craving, polyuria, polydipsia, and waking up at night to urinate (nocturia). [verywellhealth.com]

Workup

The study was exempt from institutional review board approval because, at the time of prenatal diagnosis, amniotic fluid sampling was part of the routine diagnostic workup. RESULTS Bartter groups are presented in Table 1. [nature.com]

Clinical Testing and Workup Laboratory tests that are used to diagnose these disorders include blood tests to determine serum electrolyte levels, specifically potassium, chloride, bicarbonate, magnesium, renin, and aldosterone levels and urine tests to [rarediseases.org]

The classification is as follows (see Etiology, Presentation, and Workup ) [5] : Classic Bartter syndrome and Gitelman syndrome - The first type involves the thick ascending limb of the loop of Henle (TALH) or distal convoluted tubule (DCT) dysfunction [emedicine.medscape.com]

Serum

  • Magnesium Decreased

    It is currently unknown why calcium reabsorption is increased while magnesium absorption is decreased, leading to a low level of magnesium in the blood. [en.wikipedia.org]

T Wave

  • Prominent U Wave

    […] and prominent U waves. [slideshare.net]

Treatment

The initial treatment of the patient with oral potassium was not satisfactory. Treatment with acetylsalicylic acid was associated with some effect, and an allergic reaction led withdrawal of treatment. [peertechzpublications.com]

Laboratory Values before and after the Initiation of Treatment with Rofecoxib. [nejm.org]

Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Royal Brompton & Harefield NHS Foundation Trust [rbht.nhs.uk]

Growth hormone therapy has been reported to be effective in the treatment of growth retardation and low stature associated with Bartter syndrome in some cases. [news-medical.net]

Some children require minimal management or their fluid/electrolyte balance may become normal spontaneously without treatment. [verywellhealth.com]

Prognosis

Long-term prognosis is guarded. Lack of satisfactory control may lead to morbidity, growth failure, and renal insufficiency [2, 18, 23]. 8. Prognosis Untreated ABS patients may succumb to dehydration, dyselectrolytemia, and intercurrent infections. [hindawi.com]

Prognosis If recognised early and treated aggressively, children with Bartter syndrome can achieve near-normal growth and intellectual development. [medical-dictionary.thefreedictionary.com]

With early treatment of the electrolyte imbalances the prognosis for patients with Classic Bartter Syndrome is good. History The condition is named after Dr. Frederic Bartter, who, along with Dr. [dictionnaire.sensagent.leparisien.fr]

This can help prevent serious complications from developing in them What is the Prognosis of Bartter Syndrome? (Outcomes/Resolutions) Bartter Syndrome is an incurable condition. [dovemed.com]

Etiology

Mineralocorticoid excess Cystic fibrosis Renal Tubular Defects Category Fanconi Syndrome Bartter Syndrome Gitelman Syndrome Liddle Syndrome Defect localization Proximal tubule Thick ascending loop of Henle Distal convoluted tubule Collecting tubule Etiology [step1.medbullets.com]

An etiology of Bartter syndrome that is usually known as autosomal dominant hypocalcemia or autosomal dominant hypoparathyroidism has been described. [emedicine.medscape.com]

Etiology Bartter syndrome results from a defect in sodium, potassium and chloride reabsorption at the level of Henle's loop. [orpha.net]

Epidemiology

EPIDEMIOLOGY The exact prevalence of this disorder is unknown, although it likely affects about 1 per million people worldwide. Annual incidence is estimated at 1/830,000. [flipper.diff.org]

Introduction Clinical definition a renal tubular disorder characterized by hypokalemia hypochloremia metabolic alkalosis normotension elevated plasma renin level Epidemiology incidence rare precise incidence is unknown demographics neonatal cases can [step1.medbullets.com]

Introduction Clinical definition a renal tubular disorder characterized by hypokalemia hypochloremia metabolic alkalosis normotension elevated plasma renin level Epidemiology incidence rare precise incidence is unknown demographics in neonatal cases can [medbullets.com]

Summary Epidemiology Annual incidence is estimated at 1/1000,000 in Europe. [orpha.net]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Pearls and Other Issues Enhancing Healthcare Team Outcomes Review Questions References [pubmed.ncbi.nlm.nih.gov]

Pathophysiology

Trials.gov US National Guidelines Clearinghouse NICE Guidance FDA on Bartter syndrome pathophysiology CDC on Bartter syndrome pathophysiology Bartter syndrome pathophysiology in the news Blogs on Bartter syndrome pathophysiology Directions to Hospitals [wikidoc.org]

Novel insights into the pathophysiology, as well as the recent identification of a novel genetic cause of aBS, merit an update on this topic. [journals.lww.com]

Hypokalemia pathophysiology includes studying the effect of low potassium levels on the body. [bblc.tv]

Epidemiology incidence rare precise incidence is unknown demographics neonatal cases can be suspected before birth and diagnosed soon after birth classic cases begins around 2 years of age or younger no race or sex predilection risk factors family history Pathophysiology [step1.medbullets.com]

"Physiology and pathophysiology of the renal Na-K-2Cl cotransporter (NKCC2)". American Journal of Physiology. Renal Physiology. 307 (9): F991–F1002. doi:10.1152/ajprenal.00432.2014. [en.wikipedia.org]

Prevention

Other measures include taking potassium supplements, medications to prevent potassium loss from kidneys, and if required, kidney transplantation in case of end-stage renal disease Currently, there are no effective means of preventing Bartter Syndrome; [dovemed.com]

There is no known preventive method that can keep the disorder from occurring as it has a genetic etiology. [hxbenefit.com]

To preserve the kidney function, treatment must include preventing factors damaging the kidneys. genetics paediatrics congenital disorders Statistics from Altmetric.com Request Permissions If you wish to reuse any or all of this article please use the [casereports.bmj.com]

In younger children growth hormone may be used to prevent the short stature and prostaglandin inhibitors to decrease the elevated prostaglandin levels. [flipper.diff.org]

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