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Kidney Diseases

Indomethacin response to Bartter`s Syndome

03/27/2008

Question:

My daughter was diagnosed with Bartter’s syndrome last June, and she’s on indomethacin suspension dose 5mg/ml. At the moment, she’s on 8 mls daily, but the dose is being increased every 6 to 8 weeks.

Are there any studies being done on different treatments? And does the body get so used to Indomethacin that in time it won’t have an effect anymore?

Answer:

The current treatments for Bartter's are aimed at bringing blood potassium and magnesium levels back up to normal, either by 1) lowering the amount of potassium and magnesium in the urine, or 2) replacing the urinary losses with oral supplements of potassium and magnesium. 

Medications used to accomplish step 1) include indomethacin; so-called "potassium-sparing" diuretics such as spironolactone or amiloride; and/or "ACE inhibitors" such as lisinopril. 

If blood potassium and magnesium levels can be normalized, patients usually feel better, and growth in kids accelerates.  There can be some side effects of both the meds and the supplements, however; so their use needs to be very carefully monitored.

As far as experimental treatments on the horizon, there is some promise in the future of genetic manipulations to correct the actual problem that causes the Bartter's.  These approaches are far from being ready for use in humans, however.  I hope this information is helpful to you, and that your daughter will do well with the current treatments. 

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University