Renal salt wasting without cerebral disease: Diagnostic value of urate determinations in hyponatremia J.K. Maesaka, N. Miyawaki, T. Palaia, S. Fishbane,

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Presentation transcript:

Renal salt wasting without cerebral disease: Diagnostic value of urate determinations in hyponatremia J.K. Maesaka, N. Miyawaki, T. Palaia, S. Fishbane, J.H.C. Durham Kidney International Volume 71, Issue 8, Pages 822-826 (April 2007) DOI: 10.1038/sj.ki.5002093 Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 1 Urine osmolality and serum sodium concentration during saline infusion at 125ml/h. Serum osmolality ranged between 260 and 268mosM/kgH2O in the first 15h of the study. Kidney International 2007 71, 822-826DOI: (10.1038/sj.ki.5002093) Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 2 Persistence of hypouricemia and increased fractional urate excretion after correction of hyponatremia during saline infusion at 125ml/h. Kidney International 2007 71, 822-826DOI: (10.1038/sj.ki.5002093) Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 3 Algorithm for work-up of non-edematous hyponatremia. (a) Work-up of non-esematous hyponatremia. Suggested step-wise evaluation of a patient with non-edematous hyponatremia. Interpretation of UNa is not valid in patients taking diuretics, has chronic renal disease, or is acutely vomiting. UNa in SIADH and renal salt wasting (RSW) can be low if the patient is on a low sodium diet as in the present case report. Coexistence of hypouricemia and hyponatremia will favor the diagnosis of SIADH and renal salt wasting. (b) Differentiation of SIADH from renal salt wasting. Major difference is the state of ECV. *Renin levels can be normal in renal salt wasting if the patient is on a normal to high salt diet. Renin and aldosterone in SIADH may be low normal to low. Other than assessment of ECV, the other parameters are not available on first encounter. ECV=extracellular volume, ANPBNP=atrial/brain natriuretic peptide. Kidney International 2007 71, 822-826DOI: (10.1038/sj.ki.5002093) Copyright © 2007 International Society of Nephrology Terms and Conditions