Bartter’s Syndrome – A Dilemma of Cause and Effect

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Abstract
Six interrelated abnormalities of Bartter’s syndrome are analyzed – juxtaglomerular hyperplasia, angiotensin resistance, altered kallikrein-kinin system, hyperprostaglandinuria, hypokalemia, and chloride-losing nephropathy. Arguments are advanced that any one of these could be the proximate cause and result in all the others. By the same token, each abnormality could be a consequence of any of the others and, furthermore, modulate the others by negative or positive feedback. Despite many recent insights, available data do not permit a definitive conclusion as to the locus of the primary abnormality. Rather, the syndrome presents as a remarkable biological counterpart to an electronic integrated circuit. The altered physiology of Bartter’s syndrome is reviewed and the pathogenesis of the syndrome analyzed in the light of recent literature.

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