Prolonged Hypokalemia Long After Causative Factor Elimination in Pseudo-Bartter/Gitelman Syndrome

Abstract Pseudo-Bartter/Gitelman syndrome (PBS/PGS) results from medication and lifestyle factors, causing hypokalemia and potential kidney dysfunction. Treatment involves eliminating the underlying causes, typically leading to rapid improvement. However, PBS/PGS findings may persist long after the removal of causative factors, and its pathogenesis remains unclear. This study focused on 49 cases diagnosed with PBS/PGS based on apparent causes; the cases had no pathogenic variants related to hereditary kidney diseases. They were categorized into two groups: the current group (n = 39), where causative factors persisted, and the past group (n = 10), where more than one year had elapsed since the elimination of the causative factors at the time of examination. A retrospective comparative analysis was conducted between these groups. All patients were female, except for two in the current group. The median time since the elimination of causes in the past group was 7.5 years. Hypokalemia and kidney dysfunction were observed in both groups without statistically significant differences. Both groups exhibited overactivation of renin-angiotensin systems. This study is the first to reveal the possibility of persistent PBS/PGS findings even after the removal of causative factors. While swift removal of the cause of PBS/PGS is crucial, long-term post-removal monitoring is essential to improve renal prognosis.