Copeptin-based classification of five subtypes of the syndrome of inappropriate antidiuresis (SIAD). Copeptin-based classification of five subtypes of.

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Copeptin-based classification of five subtypes of the syndrome of inappropriate antidiuresis (SIAD). Copeptin-based classification of five subtypes of the syndrome of inappropriate antidiuresis (SIAD). The shaded gray area and the black dashed line show the normal physiologic relationship between serum osmolality and plasma copeptin (as surrogate marker for vasopressin). In SIAD type B this relationship is intact, but the osmotic threshold for vasopressin release has decreased. In SIAD types A and C vasopressin release is no longer regulated by serum osmolality. In SIAD type D plasma copeptin levels are undetectable. In SIAD type E the normal relationship between serum osmolality and copeptin has reversed. This phenomenon has been coined “barostat reset,” as it may indicate increased sensitivity of baroreceptors to increased vasopressin release. Percentages indicate how often each subtype was present in one study of 50 patients. Data on the basis of Fenske et al.55 and figure modified from Fenske et al.116 with permission. Ewout J. Hoorn, and Robert Zietse JASN 2017;28:1340-1349 ©2017 by American Society of Nephrology