Indomethacin in Bartter's syndrome: does the syndrome represent a state of hyperprostaglandinism?

In three patients with Bartter's syndrome, indomethacin administration resulted in the disappearance of the hypokalemic alkalosis and in a normalization of the elevated plasma renin activity. Changes in calcium and phosphate metabolism during indomethacin medication seemed to indicate an increase in reabsorption activity of the renal proximal tubulus. A kidney biopsy performed in one of the patients showed, besides hyperplasia of juxtaglomerular cells, hyperplasia of interstitial medullary cells which are presumed to produce prostaglandins. As indomethacin is a well-known inhibitor of prostaglandin synthesis, the observations suggest that an overproduction of renal prostaglandins could well be of pathogenetic significance in Bartter's syndrome.