Cerebral Salt Wasting Versus SIADH

Sterns, Richard H.; Silver, Solomon

doi:10.1681/asn.2007101118

Cited by 123 publications

(102 citation statements)

References 27 publications

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“…In the absence of an elevated FEphosphate, it might be prudent to use hypertonic saline as suggested, (4) and to await results of the renin and aldosterone determinations or persistence of an elevated FEurate after correction of hyponatremia to decide whether to water restrict or administer isotonic saline. As in any case of chronic hyponatremia, it is prudent to increase serum sodium by Ͻ10 mmol/L/24 h to prevent osmotic demyelination syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…RSW is best defined as extracellular volume (ECV) depletion caused by a tubular defect in sodium transport with or without hyponatremia or urinary sodium (UNa) Ͼ 20 mmol/L. Unfortunately, the clinical assessment of ECV, the only differentiating variable on first encounter, is fraught with errors unless invasive procedures, such as determination of blood volume by radioisotope dilution methodology, pulmonary wedge, or central venous pressures are used (1)(2)(3)(4). The determination of ECV by tenuous clinical criteria in the original description of RSW may have contributed to the belief that this was a case of SIADH and not RSW (7).…”

mentioning

confidence: 99%

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More on Renal Salt Wasting Without Cerebral Disease

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Imbriano

Miyawaki

et al. 2009

Clinical Journal of the American Society of Nephrology

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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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More on Renal Salt Wasting Without Cerebral Disease

Bitew

Imbriano

Miyawaki

et al. 2009

Clinical Journal of the American Society of Nephrology

116

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“…Otro autor sugiere que, si no se puede probar si hay diferencias entre la EPS y SIADH, debe darse el mismo tratamiento: sodio. Sugiere que el nombre de "cerebral salt wasting syndrome" pudiera cambiarse por "cerebral salt wasting syndrome" 26 .…”

Section: Discussionunclassified