I can’t remember, which syndrome acts like a loop diuretic?

Today at VA Morning Report we talked about Bartter and Gitelman syndrome. Below is a link to a review article from Pediatric Nephrology written by Dr. Seyberth and Dr. Schlingmann.

Key Points:

  • Bartters and Gitelman syndromes are considered salt-losing tubulopathies with secondary hyperaldosteronism.
  • Two segments of the distal nephron are involved in these tubulopathies: thick ascending limb and distal convoluted tubule.
  • Bartters syndrome involves defects in the thick ascending limb, and thus mimics loop diuretics.
  • Gitelman syndrome has defects in the distal convoluted tubule and mimics thiazide diuretics.
  • There are several subtypes of each syndrome based on a particular genetic defect.
  • Both syndromes are characterized by hypokalemia, metabolic alkalosis, polyuria.
  • One of the key distinctions between these two syndromes is the association of high urinary calcium excretion in Bartters but not Gitelman. Thus, it’s important to obtain an accurate 24 hour urine calcium collection.
  • Gitelman syndrome has a more profound hypomagnesemia than Bartters.


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