Numerous causes of this syndrome probably exist. Diagnostic pointers include high urinary potassium and chloride despite low serum values, increased plasma renin, hyperplasia of the juxtaglomerular apparatus on kidney biopsy, and careful exclusion of diuretic abuse. Excess production of prostaglandins by the kidneys is often found. Magnesium wasting may also occur. Homozygous patients experience severe hypercalciuria and nephrocalcinosis. Pathophysiology
Bartter syndrome is caused by mutations of genes encoding proteins that transport ions across renal cells in the thick ascending limb of the nephron also called as the ascending loop of Henle. Specifically, mutations directly or indirectly involving the Na-K-2Cl cotransporter are key. The Na-K-2Cl cotransporter is involved in electroneutral transport of one sodium, one potassium, and two chloride ions across the apical membrane of the tubule. The basolateral calcium-sensing receptor has the ability to downregulate the activity of this transporter upon activation. Once transported into the tubule cells, sodium ions are actively transported across the basolateral membrane by Na+/K+-ATPases, and chloride ions pass by facilitated diffusion through basolateral chloride channels. Potassium, however, is able to diffuse back into the tubule lumen through apical potassium channels, returning a net positive charge to the lumen and establishing a positive voltage between the lumen and interstitial space.
Frequent colon cleansing can lead to dependence on enemas to defecate and some herbs may reduce the effectiveness of, or increase the risks associated with the use of prescription medications. Effectiveness and risks
The symptoms that are attributed to autointoxication—headache, fatigue, loss of appetite and irritability—may be caused by mechanical distention within the bowel, such as irritable bowel syndrome, rather than toxins from putrefying food. The benefits anecdotally attributed to colon cleansing are vague and the claims made by manufacturers and practitioners are based on a flawed understanding of the body. There is little evidence of actual benefit to the procedure, and no evidence that it can alleviate the symptoms that are attributed to the theories of colon cleansing.As the colon normally expels waste, colon cleansing is generally unneeded. Colonic irrigation can disrupt the bowels normal flora, and, if done frequently, can result in electrolyte depletion with dehydration. Rare but severe adverse events have been rectal perforation, as well as amoebic infection, from poorly sterilised equipment. Others claim that colon cleansing may impede the colons shedding of dead cells.Excessive use of enemas has also been associated with heart problems, such as heart failure, as well as heart attacks related to electrolyte imbalances when performed as a coffee enema. Frequent enemas or other colon-cleansing tools may lead to dependence and inability to defecate without assistance, as well as potential withdrawal symptoms. Herbs taken orally may modulate the absorption or the activity of prescription medications.Medical doctor Harriet Hall writes that "The colon cleanses itself...