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Renin, antidiuretic hormone (ADH), and ADH receptor levels in cerebral salt wasting associated with tuberculous meningitis

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Abstract

Background

To evaluate serum antidiuretic hormone (ADH), its receptors, and renin levels in cerebral salt wasting (CSW) in tuberculous meningitis (TBM).

Methods

Patients diagnosed with definite (n = 30) or probable TBM (n = 47) who developed hyponatremia (CSW, SIADH, or miscellaneous causes) were included. Sequential measurement of serum ADH, ADH-R, and renin activity by enzyme-linked immunosorbent assay was done and correlated with serum sodium level, urinary output, and fluid balance.

Results

Out of 79 TBM patients, CSW was observed in 36, SIADH in four, and miscellaneous hyponatremia in eight patients. CSW patients had a longer hospital stay (P < 0.001), lower GCS score (P < 0.007), higher MRC grade (P < 0.007), and a lower serum Na (P < 0.001) compared to non-CSW TBM patients. In severe CSW patients, serum ADH and ADH-R were correlated with hyponatremia and returned to baseline on correction; however, serum renin levels remained elevated. Serum ADH was related to hyponatremia but ADH-R and renin were not. ADH-R and renin levels did not significantly differ in CSW and SIADH.

Conclusion

CSW is the commonest cause of hyponatremia in TBM and correlates with disease severity. ADH is related to hyponatremia, but ADH receptor and renin are not.

Highlights

  • Hyponatremia in TBM is a frequent finding, attributable to CSW.

  • Differentiation between CSW and SIADH is crucial for their management.

  • Serum ADH was related to hyponatremia but ADH receptors and renin levels were not Serum ADH was related to  hyponatremia but ADH receptors and renin levels were not.

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Data availability

The data will be available on the reasonable request from investigator.

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Acknowledgements

We thank Mr. Shakti Kumar for secretarial help.

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Authors and Affiliations

  1. Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh, India, 226014

    Abhilasha Tripathi, Jayantee Kalita & Usha K. Misra

  2. Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Mritunjai Kumar

  3. Department of Respiratory Medicine, King George’s Medical University, Lucknow, India

    Surya Kant

Authors
  1. Abhilasha Tripathi
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  2. Mritunjai Kumar
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  3. Jayantee Kalita
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Contributions

Usha K Misra: Conceptualization, investigation, analysis and interpretation of data, validation, writing—original draft preparation, supervision, methodology, administration. Mritunjai Kumar: Investigation, analysis and interpretation of data, methodology, administration. Jayantee Kalita: Investigation, analysis and interpretation of data, methodology, administration, supervision, writing, and editing. Surya Kant: Investigation, analysis and interpretation of data. Abhilasha Tripathi: Collected the samples, conducted the experiments and analysis, interpretation of data, writing, and editing.

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Correspondence to Usha K. Misra.

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Tripathi, A., Kumar, M., Kalita, J. et al. Renin, antidiuretic hormone (ADH), and ADH receptor levels in cerebral salt wasting associated with tuberculous meningitis. Neurol Sci 43, 3361–3369 (2022). https://doi.org/10.1007/s10072-021-05681-6

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  • DOI: https://doi.org/10.1007/s10072-021-05681-6

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