Advertisement

Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1167–1171 | Cite as

Chronic hyponatremia in a patient with renal salt wasting and without cerebral disease: relationship between RSW, risk of fractures and cognitive impairment

  • Vittoriano Della Corte
  • Antonino Tuttolomondo
  • Rosaria Pecoraro
  • Antonio Pinto
Points of View

Abstract

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.

Keywords

Renal salt wasting syndrome Cerebral salt wasting syndrome Chronic hyponatremia SIADH Natriuretic peptides 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest with the publication of this article.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Peters JP, Welt LG, Sims EA, Orloff J, Needham J (1950) A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57–64PubMedGoogle Scholar
  2. 2.
    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):529–542CrossRefGoogle Scholar
  3. 3.
    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 CrossRefGoogle Scholar
  4. 4.
    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 2017:16–0142PubMedPubMedCentralGoogle Scholar
  5. 5.
    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):16–20CrossRefGoogle Scholar
  6. 6.
    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 CrossRefGoogle Scholar
  7. 7.
    Oh JY, Shin JI (2014) Syndrome of inappropriate antidiuretic hormone secretion and cerebral/renal salt wasting syndrome: similarities and differences. Front Pediatr 2:146PubMedGoogle Scholar
  8. 8.
    Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G (2008) Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 101:583–588CrossRefGoogle Scholar
  9. 9.
    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 119:711–718CrossRefGoogle Scholar
  10. 10.
    Schrier R (2010) Does “asymptomatic hyponatremia” exist? Nat Rev Nephrol 6(4):185CrossRefGoogle Scholar
  11. 11.
    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):766–780CrossRefGoogle Scholar
  12. 12.
    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):10864–10875CrossRefGoogle Scholar
  13. 13.
    Kavalci C, Genchallac H, Durukan P, Cevik Y (2011) Value of biomarker-based diagnostic test in differential diagnosis of hemorrhagicischemic stroke. Bratisl Lek Listy 112:398–401PubMedGoogle Scholar
  14. 14.
    Ewers M, Mielke MM, Hampel H (2010) Blood-based biomarkers of microvascular pathology in Alzheimer’s disease. Exp Gerontol 45:75–77CrossRefGoogle Scholar
  15. 15.
    Sinđić A, Dobrivojević M, Hirsch JR (2011) Natriuretic peptides in brain physiology. Transl Neurosci 2:246CrossRefGoogle Scholar
  16. 16.
    Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM (2009) Natriuretic peptides: their structures, receptors, physiologic functions and therapeutic applications. Handb Exp Pharmacol 191:341–366CrossRefGoogle Scholar
  17. 17.
    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 448:208–211CrossRefGoogle Scholar
  18. 18.
    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 31:6947–6955CrossRefGoogle Scholar
  19. 19.
    Cao LH, Yang XL (2008) Natriuretic peptides and their receptors in the central nervous system. Prog Neurobiol 84:234–248CrossRefGoogle Scholar
  20. 20.
    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):2518–2529CrossRefGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  • Vittoriano Della Corte
    • 1
  • Antonino Tuttolomondo
    • 1
  • Rosaria Pecoraro
    • 1
  • Antonio Pinto
    • 1
  1. 1.U.O.C. di Medicina Interna Con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.)University of PalermoPalermoItaly

Personalised recommendations