Tsukamoto T, Kobayashi T, Kawamoto K, Fukase M, Chihara K
Department of Medicine, Kobe University School of Medicine, Japan.
Am J Kidney Dis. 1995 Apr;25(4):637-41. doi: 10.1016/0272-6386(95)90137-x.
We observed two patients who had hypokalemic metabolic alkalosis as well as hypomagnesemia and hypocalciuria with elevated serum renin levels. In renal clearance studies in our patients using furosemide or thiazide, urine volume and chloride clearance (CCI) were increased after furosemide administration but not after thiazide administration. Furthermore, the distal fractional chloride reabsorption [CH2O/(CH2O + CCI)] was dramatically decreased by furosemide administration in our patients, whereas thiazide had little effect on it, suggesting the presence of a defect in the distal tubule rather than in the thick ascending loop of Henle. These findings are compatible with the concept of Gitelman's syndrome, a variant form of Bartter's syndrome.
我们观察到两名患者出现低钾血症性代谢性碱中毒，同时伴有低镁血症和低钙尿症，血清肾素水平升高。在我们的患者中使用呋塞米或噻嗪类药物进行肾脏清除率研究时，给予呋塞米后尿量和氯清除率（CCI）增加，但给予噻嗪类药物后未增加。此外，在我们的患者中，给予呋塞米后远端氯分数重吸收[CH2O/(CH2O + CCI)]显著降低，而噻嗪类药物对此影响很小，提示远端小管而非髓袢升支粗段存在缺陷。这些发现与吉特曼综合征（一种巴特综合征的变异形式）的概念相符。
