<prompt> In Barters Syndrome, what is seen-Metabolic acidosisHypokalemiaHyperkalemiaDecrease in urinary calcium  <response>: Ans. is b i.e., Hypokalemia o In Bartters syndrome the B.P. is low to normal despite increased level of aldosterone.Pathogenesis of Bartter SyndromeDefect in sodium chloride and potasium transportin the ascending loop of henleLoss of sodium and chlorideVolume contractionStimulation of Renin angiotensinIncreased secretion of AldosteronePromotes sodium uptake and potassiumexcretionHypokalemia -Polyuria NocturiaIncreased prostaglandin EFurther activates the reninangiotensin axiso Classic Bartter s syndrome presents during childhoodo Weakness and cramps occur secondary to hypokalemiaQo Polyuria and nocturia are common due to hypokalemiaQo Nephrocalcinosis due to hvpercalciuriaDiagnosis of Bartters Svndrome :o Hypo kalemiaQo Metabolic alkalosisQo Blood pressure is usually normalQo Urinary-potassium, calcium and sodium elevatedQ.o Serum renin, aldosterone and postaglandin E elevatedQ.o Renal function is typically normalQ.There are two types ofBartter syndromeAntenatalClassicBartter syndromeBartter syndromeo More severe o Presents in infancy o Polyhydramnios associated o Salt wasting o Severe dehydration Also know,Gittemans Syndromeo Autosomal recessive traito Caused due to mutation in thiazide sensitive Na-Cl transporterQ.o Loss of activity of the thazide sensitive transporter increases tubular calcium reabsorption leading toclassic finding of hypoclaciuria in Gitlemans syndrome.o There is also decrease in Na reabsorptionQ leading to volume depletion and hypokalemia.Gitlemans syndrome is a close differential diagnosis of Barters syndrome -SimilaritiesDifferenceso Hypokalemiao Hypomagnesemiao Metabolic acidosiso Hypocalciuriao Salt wasting o Elevated renin and aldosterone o Normal blood pressure It is usually diagnosed during adolescence or adulthood with fatigue, weakness, muscle cramps, nocturia. 