Chronic hyponatremia in a patient with renal salt wasting and without cerebral disease: relationship between RSW, risk of fractures and cognitive impairment
Tóm tắt
Renal salt wasting syndrome (RSW) is defined as a renal loss of sodium leading to hyponatremia and a decrease in extracellular fluid volume (ECV). Differentiation of this disorder from the syndrome of inappropriate antidiuretic hormone secretion (SIADH), a common cause of hyponatremia, can be difficult because both can present with hyponatremia and concentrated urine with natriuresis. Our clinical case about a 78-year-old woman with a recent fracture of the right femur not only confirms that this syndrome can occur in patients without intracranial pathologies (CT documented), but depicts how the hyponatremia caused by RSW can show a chronic, oscillating course. This is an interesting point of view because it suggests to us to consider RSW in the differential diagnosis of patients with chronic hyponatremia.
Tài liệu tham khảo
Peters JP, Welt LG, Sims EA, Orloff J, Needham J (1950) A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57–64
Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23(4):529–542
Maesaka JK, Miyawaki N, Palaia T, Fishbane S, Durham JHC (2007) Renal salt wasting without cerebral disease: diagnostic value of urate determinations in hyponatremia. Kidney Int 71(8):822–826 Epub 2007 Feb 21
Taylor P, Dehbozorgi S, Tabasum A, Scholz A, Bhatt H, Stewart P, Kumar P, Draman MS, Watt A, Rees A, Hayhurst C, Davies S (2017) Cerebral salt wasting following traumatic brain injury. Endocrinol Diabetes Metab Case Rep 2017:16–0142
Oruckaptan HH, Ozisik P, Akalan N (2000) Prolonged cerebral salt wasting syndrome associated with the intraventricular dissemination of brain tumors. Report of two cases and review of the literature. Pediatr Neurosurg 33(1):16–20
Cerdà-Esteve M, Cuadrado-Godia E, Chillaron JJ, Pont-Sunyer C, Cucurella G, Fernández M, Goday A, Cano-Pérez JF, Rodríguez-Campello A, Roquer J (2008) Cerebral salt wasting syndrome: review. Eur J Intern Med 19(4):249–254 Epub 2008 Mar 7
Oh JY, Shin JI (2014) Syndrome of inappropriate antidiuretic hormone secretion and cerebral/renal salt wasting syndrome: similarities and differences. Front Pediatr 2:146
Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G (2008) Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 101:583–588
Renneboog B, Musch W, Vandemergel X, Mantu MU, Cedaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119:711–718
Schrier R (2010) Does “asymptomatic hyponatremia” exist? Nat Rev Nephrol 6(4):185
Fujisawa H, Sugimura Y, Takagi H, Mizoguchi H, Takeuchi H, Izumida H, Nakashima K, Ochiai H, Takeuchi S, Kiyota A, Fukumoto K, Iwama S, Takagishi Y, Hayashi Y, Arima H, Komatsu Y, Murata Y, Oiso Y (2016) Chronic hyponatremia causes neurologic and psychologic impairments. J Am Soc Nephrol 27(3):766–780
Barsony J, Sugimura Y, Verbalis JG (2011) Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem 286(12):10864–10875
Kavalci C, Genchallac H, Durukan P, Cevik Y (2011) Value of biomarker-based diagnostic test in differential diagnosis of hemorrhagicischemic stroke. Bratisl Lek Listy 112:398–401
Ewers M, Mielke MM, Hampel H (2010) Blood-based biomarkers of microvascular pathology in Alzheimer’s disease. Exp Gerontol 45:75–77
Sinđić A, Dobrivojević M, Hirsch JR (2011) Natriuretic peptides in brain physiology. Transl Neurosci 2:246
Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM (2009) Natriuretic peptides: their structures, receptors, physiologic functions and therapeutic applications. Handb Exp Pharmacol 191:341–366
Fujikawa H, Kanno T, Nagata T, Nishizaki T (2008) The phosphodiesterase III inhibitor olprinone inhibits hippocampal glutamate release via a cGMP/PKG pathway. Neurosci Lett 448:208–211
Gallo EF, Iadecola C (2011) Neuronal nitric oxide contributes to neuroplasticity-associated protein expression through cGMP, protein kinase G, and extracellular signal-regulated kinase. J Neurosci 31:6947–6955
Cao LH, Yang XL (2008) Natriuretic peptides and their receptors in the central nervous system. Prog Neurobiol 84:234–248
Kondo E, Yasoda A, Fujii T, Nakao K, Yamashita Y, Ueda-Sakane Y, Kanamoto N, Miura M, Arai H, Mukoyama M, Inagaki N, Nakao K (2015) Increased bone turnover and possible accelerated fracture healing in a murine model with an increased circulating C-type natriuretic peptide. Endocrinology 156(7):2518–2529