Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Balanitis Bartter’s Syndrome 223

■With infectious lesions such as chancroid, syphilis, or gonorrhea,

complete resolution of the lesion should be documented after treat-

ment.

■Follow-up for condyloma – patient instructed to present to the office

whenever recurrence is noted. This enables early topical treatment

before lesion progresses in size.

■Follow-up for premalignant lesions of the penis mandatory

■If diagnosis of Bowen’s disease, erythroplasia of Queyrat, or balanitis

xerotica obliterans made, periodic self-inspection as well as regular

examination in the office required after excision

complications and prognosis

■Complications due to lack of appropriate diagnosis

■Unrecognized squamous cell carcinoma of the penis may progress

and metastasize.

Bartter’s Syndrome...................................

MICHEL BAUM, MD

history & physical

■may have a history of polyhydramnios and prematurity

■polydipsia, polyuria, failure to thrive, constipation, muscle cramps,

salt craving

tests

■Hypokalemia, metabolic alkalosis, with or without hypomagne-

semia

■Fractional excretion of Na and Cl >1%, usually UCa/UCr >0.20

■Elevated plasma renin, aldosterone and urinary prostaglandins

■Nephrocalcinosis common

differential diagnosis

■Autosomal recessive defect in thick ascending limb transport due to

mutation in thick ascending limb Na/K/2Cl cotransporter, Cl chan-

nel, K channel, Barttin (Cl−channel beta-subunit necessary for renal

Cl−reabsorption – associated with deafness due to defect in inner

ear K+secretion)

Very rarely, autosomal dominant hypocalcemia, caused by gain-of-

function mutations in calcium sensing receptor, is associated with

Bartter’s.