[Therapy of Bartter syndrome with indomethacin]

In two children with typical clinical and laboratory findings of the B. S., the therapeutic effect of the prostaglandin synthetase inhibitor indomethacin could be unequivocally proved in balance studies performed under inpatient conditions. Under this medication, the serum potassium rose significantly and the potassium balance became positive. In parallel to this, the plasma renin (and in the case in which it could be regularly investigated also the plasma aldosterone) fell significantly. In one of the two patients, the hypertensin-test was performed before and under indomethacin treatment; the initial angiotensin resistance could be eliminated by Indocid. Both children have now already received Indocid for twenty-four and sixteen months. The preparation was adequately tolerated, and the clinical symptoms of B. S. have largely subsided. Noteworthy is a substantial catching up of growth in one of the two patients. Despite normal renin and aldosterone values, there was no complete normalization of the serum potassium, indicating that besides the elevation of certain renal prostaglandins in the pathogenesis of B. S. described by several authors, an additional (probably superordinate) mechanism is likely to play a role.