Long-term evolution and growth patterns in a family with Bartter's syndrome.

The five-year evolution of three siblings of a sibship affected by a combined potassium and magnesium wasting abnormality associated with hypocalciuria is presented. Fractional distal chloride reabsorption was low. A number of therapeutic measures were attempted with partial or no success. Consequently, patients were kept on oral potassium and magnesium supplementation only. Special attention was paid to nutritional status. Although the three girls maintained a plasma potassium range of 2.6 to 3 meq/l, sexual and mental maturation were not delayed. Growth remained within the lower limits of normality. Considering the poor results obtained from treatment and the side-effects, we conclude that this long-term approach is sound, at least, in less severe cases of Bartter's syndrome.

Oxalate, silicon and vanadium in acquired cystic kidney disease.

We have investigated the importance of several clinical and laboratory parameters on the development of acquired cystic kidney disease (ACKD) as detected by ultrasonography in 19 patients who had received dialysis therapy for at least three years. We were particularly interested on the possible effect of the serum levels of oxalate and silicon, which can produce tubular obstruction, and that of vanadium, which can affect cell proliferation. The severity of ACKD increased with the duration of dialysis and was greater in men than in women. Positive correlations were observed between the grades of ACKD and the levels of hemoglobin, hematocrit, and parathyroid hormone, while there was a negative correlation between ACKD and serum ferritin levels. The serum levels of oxalate, silicon, and vanadium, pre- and postdialysis, were markedly and significantly higher than those in normal controls, but there was no significant correlation between these levels and the duration of dialysis therapy or severity of ACKD. The pre- and postdialysis levels of vanadium were not significantly different, while the levels of oxalate and silicon were significantly lower in the postdialysis samples. No significant correlations were detected between ACKD and age of the patients, blood pressure, protein catabolic rate, efficiency of dialysis index, or the serum levels of iron, sodium, potassium, calcium, phosphorus, aluminum, and beta 2-microglobulin.

Serum ferritin in haemodialysis.

A rapid assay for serum ferritin was performed in old and new patients undergoing regular dialysis treatment. The mean values were higher in the patients, especially the older patients, than in the controls. The normal differences in serum ferritin with age and sex were absent in the patients. We attribute these changes to iron loss and multiple transfusions received. Tissue iron was well reflected by serum ferritin concentration even during iron treatment, unless the intravenous route was used. Although an acceptable rise of serum ferritin was obtained, results of the iron administration have been poor.