Treatment of Bartter syndrome. Unsolved issue
Objective: To describe the results of a long‐term follow‐up of Bartter syndrome patients treated with different drugs. Method: Patients were diagnosed according to clinical and laboratory data. Treatment protocol was potassium supplementation, sodium, spironolactone, and non‐steroidal anti‐inflammat...
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| Format: | Article |
| Language: | Portuguese |
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Brazilian Society of Pediatrics
2014-09-01
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| Series: | Jornal de Pediatria (Versão em Português) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2255553614001062 |
| _version_ | 1811193089997406208 |
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| author | Carla Lessa Pena Nascimento Cecilia Lopes Garcia Benita Galassi Soares Schvartsman Maria Helena Vaisbich |
| author_facet | Carla Lessa Pena Nascimento Cecilia Lopes Garcia Benita Galassi Soares Schvartsman Maria Helena Vaisbich |
| author_sort | Carla Lessa Pena Nascimento |
| collection | DOAJ |
| description | Objective: To describe the results of a long‐term follow‐up of Bartter syndrome patients treated with different drugs.
Method: Patients were diagnosed according to clinical and laboratory data. Treatment protocol was potassium supplementation, sodium, spironolactone, and non‐steroidal anti‐inflammatory drug. Patients who developed proteinuria were converted to angiotensin conversion enzyme inhibitor. The variables evaluated for each drug were Z‐score for weight and stature, proteinuria, creatinine clearance, gastrointestinal complaints, amount of potassium supplementation, serum potassium and bicarbonate levels, and findings of upper digestive endoscopy.
Results: 20 patients were included. Follow‐up was 10.1 ± 5.2 years. 17 patients received indomethacin for 5.9 ± 5.3 years; 19 received celecoxib, median of 35 months; and five received enalapril, median of 23 months. During indomethacin, a statistically significant increase was observed in the Z‐score for stature and weight, without a change in the creatinine clearance. Seven of 17 patients had gastrointestinal symptoms, and upper digestive endoscopy evidenced gastritis in three patients and gastric ulcer in four patients. During celecoxib use, a significant increase was detected in the Z‐score for stature and weight and a reduction of hyperfiltration; seven patients presented gastrointestinal symptoms, and upper digestive endoscopy evidenced mild gastritis in three. During enalapril use, no significant changes were observed in the Z‐score for stature, weight and creatinine clearance. The conversion to enalapril resulted in a significant reduction in proteinuria.
Conclusion: The authors suggest starting the treatment with celecoxib, and replacing by ACEi if necessary, monitoring the renal function. The safety and efficacy of celecoxib need to be assessed in larger controlled studies. |
| first_indexed | 2024-04-12T00:02:42Z |
| format | Article |
| id | doaj.art-2ca6f08517ae4c2e8ef7ff1c738ef5f5 |
| institution | Directory Open Access Journal |
| issn | 2255-5536 |
| language | Portuguese |
| last_indexed | 2024-04-12T00:02:42Z |
| publishDate | 2014-09-01 |
| publisher | Brazilian Society of Pediatrics |
| record_format | Article |
| series | Jornal de Pediatria (Versão em Português) |
| spelling | doaj.art-2ca6f08517ae4c2e8ef7ff1c738ef5f52022-12-22T03:56:12ZporBrazilian Society of PediatricsJornal de Pediatria (Versão em Português)2255-55362014-09-0190551251710.1016/j.jpedp.2014.01.009Treatment of Bartter syndrome. Unsolved issueCarla Lessa Pena Nascimento0Cecilia Lopes Garcia1Benita Galassi Soares Schvartsman2Maria Helena Vaisbich3Unidade de Nefrologia, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, BrasilUnidade de Nefrologia, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, BrasilUnidade de Nefrologia, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, BrasilUnidade de Nefrologia, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, BrasilObjective: To describe the results of a long‐term follow‐up of Bartter syndrome patients treated with different drugs. Method: Patients were diagnosed according to clinical and laboratory data. Treatment protocol was potassium supplementation, sodium, spironolactone, and non‐steroidal anti‐inflammatory drug. Patients who developed proteinuria were converted to angiotensin conversion enzyme inhibitor. The variables evaluated for each drug were Z‐score for weight and stature, proteinuria, creatinine clearance, gastrointestinal complaints, amount of potassium supplementation, serum potassium and bicarbonate levels, and findings of upper digestive endoscopy. Results: 20 patients were included. Follow‐up was 10.1 ± 5.2 years. 17 patients received indomethacin for 5.9 ± 5.3 years; 19 received celecoxib, median of 35 months; and five received enalapril, median of 23 months. During indomethacin, a statistically significant increase was observed in the Z‐score for stature and weight, without a change in the creatinine clearance. Seven of 17 patients had gastrointestinal symptoms, and upper digestive endoscopy evidenced gastritis in three patients and gastric ulcer in four patients. During celecoxib use, a significant increase was detected in the Z‐score for stature and weight and a reduction of hyperfiltration; seven patients presented gastrointestinal symptoms, and upper digestive endoscopy evidenced mild gastritis in three. During enalapril use, no significant changes were observed in the Z‐score for stature, weight and creatinine clearance. The conversion to enalapril resulted in a significant reduction in proteinuria. Conclusion: The authors suggest starting the treatment with celecoxib, and replacing by ACEi if necessary, monitoring the renal function. The safety and efficacy of celecoxib need to be assessed in larger controlled studies.http://www.sciencedirect.com/science/article/pii/S2255553614001062Bartter syndromeNon‐steroidal anti‐inflammatory drugEnalaprilProteinuria |
| spellingShingle | Carla Lessa Pena Nascimento Cecilia Lopes Garcia Benita Galassi Soares Schvartsman Maria Helena Vaisbich Treatment of Bartter syndrome. Unsolved issue Jornal de Pediatria (Versão em Português) Bartter syndrome Non‐steroidal anti‐inflammatory drug Enalapril Proteinuria |
| title | Treatment of Bartter syndrome. Unsolved issue |
| title_full | Treatment of Bartter syndrome. Unsolved issue |
| title_fullStr | Treatment of Bartter syndrome. Unsolved issue |
| title_full_unstemmed | Treatment of Bartter syndrome. Unsolved issue |
| title_short | Treatment of Bartter syndrome. Unsolved issue |
| title_sort | treatment of bartter syndrome unsolved issue |
| topic | Bartter syndrome Non‐steroidal anti‐inflammatory drug Enalapril Proteinuria |
| url | http://www.sciencedirect.com/science/article/pii/S2255553614001062 |
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