Urinary prostaglandins in Bartter's and pseudo-Bartter's syndrome.

Renal secretion of prostaglandins (PG) in Bartter's syndrome and in different forms of hypokalemic normotensive syndromes (pseudo-Bartter's syndrome) was measured to determine if it is possible to use the measurement of urinary prostaglandins for the discrimination of different etiologies. Prostaglandins E2, F2 alpha, 6-keto-PGF1 alpha and thromboxane B2 (TxB2) were measured after extraction and chromatography by radioimmunoassay in 19 patients and in 26 control healthy subjects. Bartter's syndrome may be characterized as primary renal hyperprostaglandinism with high urinary PGE2 excretion. It can be dissociated from pseudo-Bartter's syndrome because the urinary PGE2 excretion is always in the normal range in the pseudosyndrome. Abuse of loop diuretics may have effects that mimic Bartter's syndrome since these diuretics stimulate urinary prostaglandin excretion. Therefore, loop diuretics should always be excluded prior to the diagnosis of Bartter's syndrome.