Autosomal dominant hypocalcemia with mild type 5 Bartter syndrome

Giuseppe Vezzoli, Teresa Arcidiacono, Vera Paloschi, Annalisa Terranegra, Rita Biasion, Giovanna Weber, Stefano Mora, Marie Louise Syren, Domenico Coviello, Daniele Cusi, Giuseppe Bianchi, Laura Soldati

Research output: Contribution to journalArticlepeer-review


Type 5 Bartter syndrome has been recently defined as a Bartter syndrome due to the most activating mutations of the calcium-sensing receptor (CaSR). It has been attributed to the inhibition exerted by CaSR activity on sodium transport in the thick ascending limb of the loop of Henle (TALH). Two monozygotic twin sisters (T1 and T2) with autosomal dominant hypocalcemia (ADH) due to a nonconservative activating CaSR mutation in the extracellular domain (K29E) were studied. They developed a Bartter-like syndrome characterized by a mild phenotype: hypokalemia occurred only at the age of 22 years; it was corrected with small doses of oral potassium in one twin, while the other twin needed no potassium supplements to maintain borderline levels of plasma potassium; alkalosis was absent; plasma renin and aldosterone production were not markedly activated. Furthermore, the natriuretic response to furosemide, a inhibitor of sodium reabsorption in the TALH, was conserved in both twins. The K29E mutation was previously reported as one of the most activating mutations of the CaSR gene leading to a very marked increase in CaSR sensitivity to calcium ions. These findings confirm that Bartter syndrome is typically associated with ADH provided that the underlying mutation of CaSR is able to produce a conspicuous gain of function. However, the phenotype of type 5 Bartter syndrome may manifest with variable severity, not directly related with the in vitro potency of the CaSR activating mutation.

Original languageEnglish
Pages (from-to)525-528
Number of pages4
JournalJournal of Nephrology
Issue number4
Publication statusPublished - Jul 2006


  • Autosomal dominant hypocalcemia
  • Bartter syndrome
  • Calcium-sensing receptor
  • Furosemide
  • Hypercalciuria
  • Hypocalcemia
  • Hypokalemia

ASJC Scopus subject areas

  • Nephrology


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