[Bartter's syndrome: Recurrence in the course of a treatment inhibiting prostaglandin synthesis].

Two adults with Bartter's syndrome were treated first with propranolol and a potassium-sparing diuretic and then with indomethacin for 22 months. Inhibition of prostaglandin synthesis by indomethacin, confirmed by a fall in urinary excretion rate of prostaglandins E2 and F2 alpha, induced a marked decrease in plasma renin activity and aldosterone excretion rate and an increase in plasma potassium. While the first patient was well controlled by this therapy, the second had elevation of prostaglandin excretion after 8 months associated with a relapse of symptomatic hypokalemia. Reintroduction of propranolol in addition to indomethacin led to renormalization of plasma potassium. A therapeutic trial with another prostaglandin synthesis inhibitor, meclofenamate, also produced partial correction of hyperreninemia and hypokalemia but only for a short time. From these observations it is concluded that (1) inhibition of renal prostaglandins by indomethacin or meclofenamate represents an effective but transient therapy for Bartter's syndrome, and (2) while prostaglandin secretion may elude pharmacological inhibition, the addition of propranolol restores complete inhibition and the therapeutic benefits of the previous treatment.