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


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.


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


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.


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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

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