Bartter-like syndrome

Electrolyte balance Aminoglycosides cause fluid, electrolyte, and acid-base disorders by altering renal tubular function in several ways, leading to hypokalemia and acidosis or alkalosis. Stimulation of the calcium-sensing receptor has been reported to cause a Bartter-like syndrome (hypokalemic metabolic alkalosis, hypomagnesemia, hypocalcemia, and normal serum creatinine concentrations). More rarely, a proximal renal tubular acidosis (Fanconi syndrome non-anion gap metabolic acidosis) can develop. The mechanisms have been summarized [4 ]. 

Mineral balance Type 5 Bartter-like syndrome with severe hypocalcemia has been attributed to amikacin [7 ]. 

Mineral balance A 45-year-old woman developed symptomatic hj ocalcemia, with metabolic alkalosis, hj okalemia, and hypomagnesemia Bartter-like syndrome), several days after a 10-day course of gentamicin for a urinary tract infection [15 ]. Comorbidities included ovarian cancer treated with intraperitoneal dsplatin (in a dose not thought to cause renal tubular dysfunction). Recovery took 6 weeks, and sustained high-dose electrolyte replacement was required to counteract persistent urinary potassium and calcium losses. The authors suggested that a polyvalent toxin of gentamicin had caused multiple renal tubular abnormalities. 

Chen YS, Fang HC, Chou KJ, Lee PT, Hsu CY, Huang WC, Chung HM, Chen CL. Gentamicin-induced Bartter-like syndrome. Am J Kidney Dis 2009 54 (6) 1158-61. 

Cakir U, Alan S, Zeybek C, Erdeve O, Atasay B, Yalcinkaya F, et al. Acquired bartter-like syndrome associated with colistin use in a preterm infant. Ren Fail 2013 35(3) 411-3. 

Steiner RW, Omachi AS. A Bartter s-like syndrome from capreomycin, and a similar gentamicin tubulopathy. Am J Kidney Dis 1986 7(3) 245-9. 

---