Bartter's Syndrome in Pregnancy: A Case Report and Review

Abstract

Bartter's syndrome is a rare autosomal recessive disorder characterized by hypokalemia, hyperaldosteronism, sodium wasting, normal blood pressure, hypochloremic alkalosis, and hyperplasia of the juxtaglomerular apparatus. We present a 21-year-old African-American nulliparous patient who was referred to our clinic at 9 weeks' gestation with a history of Bartter's syndrome. Her antenatal course was complicated by muscle cramps, which required increasing potassium supplementation. She developed hypomagnesemia in the third trimester of pregnancy, which necessitated magnesium therapy. She delivered an unaffected infant at term. Bartter's syndrome, although extremely rare in pregnancy, requires prompt recognition and careful management, as it may have significant maternal and neonatal implications.

Successful management of an extreme example of neonatal hyperprostaglandin-E syndrome (Bartter???s syndrome) with the new cyclooxygenase-2 inhibitor rofecoxib

“…However, it does not correct the primary chloride resorption defect or improve the urinary concentration defect because indomethacin does not affect the ion channels (2,10,11,13,14). Normal growth and development is feasible for most patients treated with regular indomethacin therapy (12,14,(17)(18)(19)(20)(21)(22)(23).…”

Diagnosis and management of Bartter syndrome: executive summary of the consensus and recommendations from the European Rare Kidney Disease Reference Network Working Group for Tubular Disorders

“…The overall outcome for women with BS and their infants described to date is favorable. [90][91][92][93][94][95] After delivery, the treatment of the mother may return to baseline supplementation.…”

Is normalisation of serum potassium and magnesium always necessary in Gitelman Syndrome for a successful obstetric outcome?

“…In our patient, despite persistently low serum levels potassium and magnesium, successful and uncomplicated pregnancy was observed over three years. A review of the literature shows that low levels of potassium are not uncommon in pregnancy complicated with Bartter's Syndrome, a related disorder of renal electrolyte transport, presumably because of difficulty in maintaining normal serum levels in the face of continuing urinary loss 4–7 . We therefore, like previous authors, feel that normalisation of potassium is extremely difficult and is not essential for successful pregnancy 7 …”

“…To our knowledge, there have been a few previous case reports of Bartter's Syndrome with pregnancy 4–7,16–18 . In an extensive review of 28 patients with Bartter's Syndrome, the authors observed 40 pregnancies in 14 patients.…”