Recommended guidelines for follow-up care of Bartter syndrome

Age	Frequency of visits	History	Examination	Laboratory evaluation
Infants and young children (<2 years of age)	At least 3 to 6 months^*	Evidence of hypovolemic episodes. Determination of severity of polyuria, nutritional intake, and adherence to medical management. Review of adverse effects of medical therapy (eg, gastrointestinal symptoms for individuals on NSAIDs).	Measurement of growth parameters (ie, length, weight, and head circumference) to identify poor weight gain and growth failure. Signs and severity of hypovolemia dehydration. Signs and severity of muscle weakness.	Serum electrolytes, creatinine, BUN, and determination of acid-base status either by blood gas or venous total CO₂. Urine osmolality and calcium-to-creatinine ratio. Kidney ultrasound performed every 12 to 24 months to detect nephrocalcinosis or signs of secondary obstruction.
Children >2 years of age to 12 years of age	6 to 12 months^*	All of the above items. Evidence of pubertal delay (>8 to 9 years).	Assessment of growth based on height and weight measurements. Assessment of sexual maturation based on Tanner stages beginning at age 8 years for girls and 9 years for boys.	Serum electrolytes, creatinine, BUN, determination of acid-base status either by blood gas or venous total CO₂, and PTH. Urine osmolality and calcium-to-creatinine ratio. Kidney ultrasound performed every 12 to 24 months to detect kidney stones.
Adolescents and adults	6 to 12 months^*	Hypovolemia, degree of polyuria, signs of muscular weakness, fatigue, and palpitations.	Assessment of muscular strength.	Serum electrolytes, creatinine, BUN, determination of acid-base status either by blood gas or venous total CO₂, and PTH. Kidney ultrasound performed every 12 to 24 months to detect kidney stones. Cardiac evaluation for patients with symptoms of palpitations or syncope.

BUN: blood urea nitrogen; CO₂: carbon dioxide; NSAIDs: nonsteroidal antiinflammatory drugs; PTH: parathyroid hormone.

* Individuals clinically stable on an established medical regimen. More frequent visits may be necessary in clinically unstable patients who are undergoing management changes.

Adapted from: Konrad M et al. Diagnosis and management of Bartter syndrome: executive summary of the consensus and recommendations from the European Rare Kidney Disease Reference Network Working Group for Tubular Disorders. Kidney Int 2021; 99:324.

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Recommended guidelines for follow-up care of Bartter syndrome