Abstract
Chamiovitz, et. al., recently demonstrated a defect in sodium (NA) reabsorption in the medullary diluting segment in a patient with Bartter's Syndrome (B.S.). We performed hypotonic saline diuresis studies on a patient (J.A.) with B.S. and followed this with furosemide (F) infusion of 1mg/kg. The following table illustrates our data compared with Chamiovitz's patients and his normal controls.
Although the actual free water clearance (CH2O) in J.A. is comparable to established controls (9.2 vs. 9.0), it is reduced in relation to NA delivery to the ascending limb (CH2O + CNA) thereby supporting the contention of Chamiovitz, et. al., of defective sodium reabsorption in the diluting segment. The defect appears partial as evidenced by the change in CH2O when NA delivery was increased. Since F. reduced CH2O some NA reabsorption does occur in the medullary diluting segment in B.S. The increase in CH2O + CNA achievable as compared to controls treated similarly (19.6 vs. 11.1) might also suggest defective proximal tubular reabsorption of NA.
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Kohaut, E., Wilson, C. & Hill, L. HYPOTONIC SALINE AND FUROSEMIDE DIURESIS IN BARTTER'S SYNDROME. Pediatr Res 8, 456 (1974). https://doi.org/10.1203/00006450-197404000-00698
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DOI: https://doi.org/10.1203/00006450-197404000-00698
