Is it cerebral or renal salt wasting?

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Is it cerebral or renal salt wasting? John K. Maesaka, Louis J. Imbriano, Nicole M. Ali, Ekambaram Ilamathi Kidney International Volume 76, Issue 9, Pages 934-938 (November 2009) DOI: 10.1038/ki.2009.263 Copyright © 2009 International Society of Nephrology Terms and Conditions

Figure 1 Relationship between serum sodium, serum urate, and FEurate in SIADH and RSW. Relationship between serum sodium, serum urate, and FEurate in (a) inappropriate secretion of antidiuretic hormone (SIADH) and (b) renal salt wasting (RSW). Shaded areas represent normal values for each laboratory test. Hypouricemia and increased FEurate coexist with hyponatremia in both SIADH and RSW, but return to normal values with correction of hyponatremia in SIADH. In contrast, hypouricemia and increased FEurate persist after correction of hyponatremia in RSW. Serum sodium (orange), serum urate (green) and FEurate (red). Kidney International 2009 76, 934-938DOI: (10.1038/ki.2009.263) Copyright © 2009 International Society of Nephrology Terms and Conditions

Figure 2 Response of urine Osm and serum sodium concentration to saline infusion at 125ml/h in hyponatremic patient with hip fracture without cerebral disease. Plasma antidiuretic hormone (ADH) was undetectable when urine Osm was 178mOsm/kg water. Patient had 7.1% reduction in blood volume, increased plasma renin and aldosterone, and persistent hypouricemia and increased FEurate after correction of hyponatremia. Note prompt correction of hyponatremia after inhibition of ADH secretion and generation of dilute urine to increase free-water excretion.1 Kidney International 2009 76, 934-938DOI: (10.1038/ki.2009.263) Copyright © 2009 International Society of Nephrology Terms and Conditions