Future considerations based on the information from Barrter's and Gitelman's syndromes

Hadas Alfandary, Daniel Landau

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Purpose of review Bartter and Gitelman syndromes are typical normotensive salt losing hypokalaemic tubulopathies. Their pathogenesis was gradually deciphered in the past 5 decades, first by typical salt balance studies and histopathology, followed by genetic characterization and discovery of the affected different ion channels. Although the different genotypic subtypes were originally thought to show a similar phenotype, important clinical and biochemical differences can now be found. New findings on the regulation of these channels, as well as the recent discovery of newly affected genes, merit an update on this topic. Recent findings Na-K-2CL cotransporter and NaCl cotransporter, the two main luminal channels in the thick ascending limb and distal convoluted tubule were found to be regulated by Ste 20-related proline alanine-rich kinase and oxidative stress response kinase. Knockout mice to these channels express a Bartter-like phenotype. MAGED2 is new gene found to cause severe polyhydramnios and transient postnatal Bartter-like syndrome. Variants in the different channels causing Bartter syndromes/Gitelman syndromes may also confer susceptibility for hypertension or protect against it. Summary It remains to be determined if polymorphism or epigenetic changes in these genes and proteins may affect salt handling, explaining, apart from Bartter syndromes and Gitelman syndromes, also hypertension or stroke tendency, or both.

Original languageEnglish
Pages (from-to)9-13
Number of pages5
JournalCurrent Opinion in Nephrology and Hypertension
Volume26
Issue number1
DOIs
StatePublished - 1 Jan 2017

Keywords

  • Ascending limb of loop of Henle
  • Distal
  • Hypertension
  • Kidney tubules
  • Metabolic alkalosis
  • Polyhydramnios

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