Cerebral Salt-Wasting Syndrome: Does It Exist?

Maesaka, John K.; Gupta, Sandeep; Fishbane, Steven

doi:10.1159/000045384

Cited by 125 publications

(134 citation statements)

References 40 publications

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“…Uric acid tends to be low in both disorders. 19 Mineralocorticoid deficiency. Patients with isolated glucocorticoid deficiency from adrenocorticotropic hormone (ACTH) deficiency do not have mineralocorticoid defi-ciency, so they do not have inappropriate renal sodium wasting or hyperkalemia.…”

Section: S4mentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

523

498

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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Section: S4mentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

523

498

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“…T he differentiation of SIADH from cerebral salt wasting syndrome (CSW) or the preferred term, renal salt wasting (RSW), represents one of the diagnostic conundrums that includes the fundamental question of the existence and prevalence of RSW (1)(2)(3)(4). This conundrum exists because of multiple overlapping clinical associations and laboratory abnormalities that characterize both syndromes and the dearth of specific parameters that distinguish one syndrome from the other (1)(2)(3)(4).…”

mentioning

confidence: 99%

“…This conundrum exists because of multiple overlapping clinical associations and laboratory abnormalities that characterize both syndromes and the dearth of specific parameters that distinguish one syndrome from the other (1)(2)(3)(4). The increasing acceptance of RSW as a clinical entity among internists and the realization that RSW might be more common than previously acknowledged collectively intensify the need to differentiate one syndrome from the other (1,3,4 -6).…”

mentioning

confidence: 99%

More on Renal Salt Wasting Without Cerebral Disease

Bitew

Imbriano

Miyawaki

et al. 2009

Clinical Journal of the American Society of Nephrology

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116

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Background and objectives: The existence and prevalence of cerebral salt wasting (CSW) or the preferred term, renal salt wasting (RSW), and its differentiation from syndrome of inappropriate antidiuretic hormone (SIADH) have been controversial. This controversy stems from overlapping clinical and laboratory findings and an inability to assess the volume status of these patients. The authors report another case of RSW without clinical cerebral disease and contrast it to SIADH. Design, setting, participants, & measurements: Three patients with hyponatremia, hypouricemia, increased fractional excretion (FE) of urate, urine sodium >20 mmol/L, and concentrated urines were infused with isotonic saline after collection of baseline data.Results: One patient with RSW had pneumonia without cerebral disease and showed increased plasma aldosterone and FEphosphate, and two patients with SIADH had increased blood volume, low plasma renin and aldosterone, and normal FEphosphate. The patient with RSW responded to isotonic saline by excretion of dilute urines, prompt correction of hyponatremia, and normal water loading test after volume repletion. Hypouricemia and increased FEurate persisted after correction of hyponatremia. Two patients with SIADH failed to dilute their urines and remained hyponatremic during 48 and 110 h of saline infusion.Conclusions: The authors demonstrate appropriate stimulation of ADH in RSW. Differences in plasma renin and aldosterone levels and FEphosphate can differentiate RSW from SIADH, as will persistent hypouricemia and increased FEurate after correction of hyponatremia in RSW. FEphosphate was the only contrasting variable at baseline. The authors suggest an approach to treat the hyponatremic patient meeting criteria for SIADH and RSW and changing CSW to the more appropriate term, RSW.

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“…El único parámetro capaz de diferenciar a la EPS de SIADH es la normalización de la FEAU cuando se ha corregido la hiponatremia en SIADH y la persistencia de su alteración en EPS 23 . En esta paciente la FEAU persistió elevada días antes del alta pero la hiponatremia aún persistía.…”

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