Hypokalaemic alkalosis, acquired Gitelman's and Bartter's syndrome in chronic sialoadenitis

Abstract

Two patients with chronic sialoadenitis had features of Bartter's and Gitelman's syndrome, respectively. The main complaints were leg paraesthesiae and acute arthritis. A good response to oral K+ supplementation, allopurinol and low-dose prednisone was obtained. The features of Sjögren's-related renal diseases are reviewed.

Bartter syndrome complicated by immune complex nephropathy

“…These data are consistent with the proposal that chronic sodium-losing nephropathy, due to congenital renal dysplasia or acquired glomerulonephritis, may be the cause of some cases of Bartter syndrome [25,30]. An association of Bartter syndrome with autoimmune nephropathy is supported by the association of the Bartter biochemical phenotype with several cases of chronic sialoadenitis, often in association with Sjogren syndrome [35,36,37,38]. Sjogren syndrome is an autoimmune disease in which hypergammaglobulinemia, cryoglobulinemia, rheumatoid factors, and antibodies to the antigens SSA/RO and SSB/La may be present, and in which half of the children have other autoimmune disorders such as systemic lupus erythematosus.…”

A woman with red eyes and hypokalemia: A case of acquired Gitelman syndrome

“…We report on a patient with primary Sjögren's syndrome and associated acquired Gitelman's syndrome, to our knowledge only the third case published in the literature [2,3]. Severe combined acid-base and electrolyte disorders are typically seen in critically ill patients, but rarely in oligosymptomatic patients in the outpatient setting.…”

“…Among pathologies leading to acquired tubular disorders, myeloma light chains, amyloidosis and disorders of vitamin D metabolism have been reported, but the most frequent causes are autoimmune diseases which may induce renal electrolyte wasting. Several types of acquired renal tubular disorder have been observed in patients with various autoimmune diseases such as Sjögren's syndrome, systemic lupus erythematodes, primary biliary cirrhosis and autoimmune thyroiditis ( Table 2) [4]. Why autoimmune diseases can mimic different hereditary tubular disorders is not clear.…”

“…Whereas acquired Bartter's syndrome is quite often described as a cause of tubular dysfunction, to our knowledge there are only two reports in the literature of acquired Gitelman's syndrome resulting from autoimmune disease [2,3]. Gitelman's syndrome is a rare hereditary disease of the sodium chloride co-transporter in the renal distal tubular cells, which leads to renal loss of sodium, potassium and magnesium and clinical symptoms of muscle weakness, fatigue, salt craving and nycturia [6].…”

Acute Flaccid Quadriplegia: A Rare Case of Adult Onset Bartter’s Syndrome

“…Adult onset Bartter syndrome is very rare. They are seen in cases of diuretic abuse [2] and an association with PTB [3] ,chronic sialoadenititis [4] , exposure to gentamycin [5] and acquired idiopathic [6] case have been reported. None of these associations were relevant to our case.…”