Bartter syndrome differential diagnosis: Difference between revisions

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Revision as of 10:25, 31 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Bartter syndrome diagnosis should be differentiated from other diseases manifesting with hypokalemia and hypochloremic metabolic alkalosis.^[1]


Disease	Findings
Gitelman syndrome	Hypocalciuria (low urinary calcium) is a distinct feature and interstitial nephritis may develop because of the persistent hypokalemia. Adults can present with chondrocalcinosis with swollen and warm joints with overlying tenderness. Sudden cardiac arrest has been reported occasionally.^[2] Growth retardation is absent in Gitelman syndrome.^[3]
Diuretic abuse
Cyclical vomiting	In the case of cyclical vomiting for a variety of reasons, urine chloride concentration differs from that of Bartter syndrome. This is usually less than 25 mEq/L in patients with chronic vomiting as a result of hypovolemia and hypochloremia. In Bartter syndrome the urine chloride concentration is typically much higher (usually greater than 40 mEq/L).^[4]
Hyperprostaglandin E syndrome
Familial hypomagnesemia with hypercalciuria/nephrocalcinosis
Cystic fibrosis
Gullner syndrome - Familial hypokalemic alkalosis with proximal tubulopathy
Mineralocorticoid excess
Activating mutations of the CaSR calcium-sensing receptor
Hypomagnesemia
Congenital chloride diarrhea
Hypochloremic alkalosis
Hypokalemia

@@ Line 22: / Line 22: @@
 | style="padding: 5px 5px; background: #DCDCDC;" |'''Cyclical vomiting'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*
+*In the case of cyclical vomiting for a variety of reasons, urine chloride concentration differs from that of Bartter syndrome.
+*This is usually less than 25 mEq/L in patients with chronic vomiting as a result of hypovolemia and hypochloremia.
+*In Bartter syndrome the urine chloride concentration is typically much higher (usually greater than 40 mEq/L).<ref name="pmid425977">{{cite journal| author=Veldhuis JD, Bardin CW, Demers LM| title=Metabolic mimicry of Bartter's syndrome by covert vomiting: utility of urinary chloride determinations. | journal=Am J Med | year= 1979 | volume= 66 | issue= 2 | pages= 361-3 | pmid=425977 | doi=10.1016/0002-9343(79)90566-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=425977  }} </ref>
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''Hyperprostaglandin E syndrome'''