Correction of hypokalemia with antialdosterone therapy in Gitelman's syndrome.
Six adult patients (4 females and 2 males, age range 26-57 years) with Gitelman's syndrome (GS) were treated with spironolactone 200-300 mg/day (n = 5) and/or amiloride 10-30 mg/day (n = 3) for 1-18 months. The patients had hypokalemia, hyperreninemia, chloride-resistant metabolic alkalosis, renal hypomagnesemia (n = 5), and hypocalciuria (n = 5). Free water clearance studies during maximal water diuresis and furosemide administration were suggestive of a solute reabsorptive defect beyond the loop of Henle. Antialdosterone therapy induced a significant increase of PK (from 2.6 +/- 0.4 to 3.4 +/- 0.4 mM; p < 0.0001) and a decrease of CK (from 21.4 +/- 13.2 to 10.6 +/- 4.8 ml/min, p < 0.02) and FEK (from 21.0 +/- 13.6 to 13.4 +/- 5.7%; p < 0.03); PMg increased from 1.38 +/- 0.38 to 1.64 +/- 0.21 mg/dl (p < 0.03) with a parallel fall of CMg (from 5.5 +/- 2.3 to 2.9 +/- 1.5 ml/min; p < 0.02) and FEMg (from 5.7 +/- 2.6 to 2.9 +/- 0.6%; p < 0.05); arterial blood pH and HCO3- did not change (P = plasma, C = clearance, FE = fractional excretion). The creatinine clearance fell (from 90.5 +/- 16.8 to 65.8 +/- 20.9 ml/min; p < 0.05), and Prenin rose (from 16.6 +/- 8.9 to 35.3 +/- 25.3 ng/ml/h; p < 0.02, as did Paldo (from 26.1 +/- 12.3 to 109 +/- 82.6 ng/dl; p < 0.01), indicating extracellular fluid volume contraction; however no significant clinical symptoms of hypovolemia ensued.(ABSTRACT TRUNCATED AT 250 WORDS)
Colussi
G
G
Division of Nephrology and Dialysis, Niguarda-Ca'Granda Hospital, Milan, Italy.
Rombolà
G
G
De Ferrari
M E
ME
Macaluso
M
M
Minetti
L
L
D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000652:urine; D000584:Amiloride / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001477:Bartter Syndrome / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D001784:Blood Gas Analysis; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007008:Hypokalemia / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy / Q000652:urine; D007684:Kidney Tubules; D008274:Magnesium / Q000097:blood / Q000652:urine; D008275:Magnesium Deficiency / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011188:Potassium / Q000097:blood / Q000652:urine; D012083:Renin / Q000097:blood / Q000652:urine; D013148:Spironolactone / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013577:Syndrome
D013148:Spironolactone; D000450:Aldosterone; D000584:Amiloride; D003404:Creatinine; D012083:Renin; D008274:Magnesium; D011188:Potassium