Chronic hyponatremia in a patient with renal salt wasting. To present a case of a cerebral salt wasting syndrome secondary to a bacterial mengitis and to emphasize the difficulty to assess the diagnosis. Simple fluid restriction is recommended for the treatment of hyponatremia. Here, we report a patient with fpinduced renal saltwasting syndrome rsws who presented with severe hyponatremia with disturbance of consciousness and was admitted to the intensive care unit icu.
Differentiation of this disorder from the syndrome of inappropriate antidiuretic hormone secretion siadh, a common cause of hyponatremia, can be difficult because both can present with hyponatremia and concentrated urine with natriuresis. However, no reports of rsws following taxane monotherapy have been previously published. Cisplatininduced renal salt wasting syndrome request pdf. Sympathetic responses as well as some natriuretic factors play a role in this syndrome. Influence of dietary sodium on renal function in patients. In this condition, the kidney is functioning normally but excreting excessive sodium. In describing the lifethreatening syndrome of renal salt wasting, thorn, koepf, and clinton 1 and others 2, 3 stated that the condition is not due to a single typical pathologic lesion in the kidney. Pdf a mouse model for the renal saltwasting syndrome. Both renal salt wasting syndrome rsws and syndrome of inappropriate antidiuretic hormone secretion siadh have been reported as the underlying mechanisms for chemotherapyinduced hyponatremia. Hyponatremia associated with syndrome of inappropriate secretion of antidiuretic hormone siadh or renal saltwasting syndrome rsws after platinumbased chemotherapy is not uncommon.
The pathogenesis of this disorder is still not completely understood. Why is bartter syndrome called salt wasting nephropathy. We intend to briefly discuss the pathophysiology of rsw and siadh, current methods of differentiating siadh from rsw, the failure of the volume approach to address. A mouse model for the renal saltwasting syndrome pseudohypoaldosteronism. Syndrome of inappropriate antidiuretic hormone secretion and cerebral renal salt wasting syndrome. As such, it may be more appropriately termed renal salt wasting. With treatment, the cerebral salt wasting resolves within a few weeks to. Cerebral salt wasting vs siadh pdf free serial pdf. A trial of isotonic normal saline resulted in a further fall in serum sodium level. List of features common to syndrome of inappropriate antidiuretic hormone. Cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage.
Complexity of differentiating cerebralrenal salt wasting. Besides, the treatment principles of siadh and csws are contrary, which. Cerebral salt wasting vs siadh pdf the term cerebral salt wasting csw was introduced before the syndrome of inappropriate four years later, schwartz et. Abim invites diplomates to help develop the purpose of the. Abstract chronic renal insufficiency produced by any progressive disease of the kidney may be associated with a variety of complications. This hypothesis was later proven by demonstrating inappropriately high adh levels that did not respond to. Aacn advanced critical care volume 23, number 3, pp.
Cerebral salt wasting describes the findings of hyponatremia and excessive renal sodium excretion in patients with various affections of the central nervous system cns. Cerebral salt wasting syndrome csw is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. Here, we report a patient with fpinduced renal saltwasting syndrome rsws who presented with severe hyponatremia with disturbance of consciousness and was admitted to. Bartter syndrome is a renal tubular salt wasting disorder in which the kidneys cannot reabsorb sodium and chloride in the thick ascending limb of the loop of henle. Bartter syndrome causes, symptoms, diagnosis, prognosis. Cerebral salt wasting csw or, more appropriately, renal salt wasting rsw, is a syndrome with a controversial history that evolved from a misrepresentation of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Differentiating siadh from cerebralrenal salt wasting. Cerebral salt wasting syndrome statpearls ncbi bookshelf.
Therefore, in order to perform an appropriate treatment for hypona. Its hallmarks are renal excretion of sodium and loss of. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Congenital adrenal hyperplasia salt wasting congenital adrenal hyperplasia simple virilizing national newborn screening and global resource center nnsgrc provides information and resources in the area of newborn screening and genetics to benefit health professionals, the public health community, consumers and government officials. Case report renal salt wasting syndrome due to carboplatin. However, there are still few cases of renal saltwasting syndrome. Cerebral saltwasting syndrome is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury or the presence of tumors in or surrounding the brain. Cerebral salt wasting csw is a disorder of sodium and water handlingthatoccursasaresultofcerebraldisease inthesettingofnormalkidneyfunction. Cerebral salt wasting csw is a disorder of sodium and water handling that occurs as a result of cerebral disease in the setting of normal kidney function. Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from siadh becomes critical because of opposing therapeutic goals, which are to provide salt and water to a volume depleted patient with rsw and water restriction for a waterloaded patient with siadh. Therefore, maintenance of volume status and sodium replacement is the mainstay of treatment in csw syndrome. Coexistence of hypouricemia and hyponatremia will favor the diagnosis of siadh and renal salt wasting. Renal saltwasting syndrome associated with docetaxel in an. 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.
Hypokalemia low potassium and chloride level causes metabolic alkalosis. The salt wasting that occurs results in the following features. Abnormal renal tubule renal tubule excretes excessive potassium and chloride, which results in reduced potassium and chloride levels. Cerebral saltwasting syndrome clinical presentation. Traditionally, it is known that diseased kidneys fail to excrete nitrogenous substances, and that this retention leads to azotemia and uremia. Inappropriate antidiuretic hormone secretion and cerebral salt. Pdf differentiating siadh from cerebralrenal salt wasting. Syndrome of inappropriate antidiuretic hormone secretion. More on renal salt wasting without cerebral disease.
First described by peters et al in 1950, cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function. Cisplatin is well known for causing renal toxicity via proximal tubular damage, some cases of which present as rsws. Siadh is in a volume expanded status due to inappropriately secreted arginine vasopressin avp and requires water restriction. A syndrome of renal sodium loss and hyponatremia probably. A salt wasting syndrome associated with cerebral disease. Pdf case presentation a 76yearold woman, who sustained an accidental fracture of the femoral neck, developed hyponatremia after. Cerebral salt wasting vs siadh pdf the term cerebral salt wasting csw was introduced before the syndrome of inappropriate four years later, schwartz et al. However, these two clinical syndromes have distinct clinical characteristics and managements. Syndrome of inappropriate antidiuretic hormone and cerebral salt wasting in critically ill patients amanda zomp, pharmd, bcps earnest alexander, pharmd serum sodium levels in critically ill patients can be altered by many factors. Overview of common and distinctive features the tubular defects in sodium chloride transport produce a clinical disorder that appears similar to that seen with chronic ingestion of a loop diuretic mimicking bartter syndrome or a thiazide diuretic mimicking gitelman syndrome. He was in negative fluid balance suggesting possible renal salt wasting. Making the diagnosis rapidly is vital as its treatment requires volume resuscitation and sodium restoration rather than the water restriction used for the more. Cerebral salt wasting after traumatic brain injury.
Generating an epub file may take a long time, please be patient. Cerebral saltwasting syndrome cerebral salt wasting. Renal salt wasting syndrome has been reported in up to 10% of patients, manifesting as hyponatremia and severe orthostatic hypotension in the setting of high urinary sodium concentration. This leads to increased distal delivery of salt and excessive salt and water loss from the body. He was subsequently treated for suspected syndrome of inappropriate adh with a hypertonic 3% saline infusion. The 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 14. Itischaracterized by hyponatremia in association with hypovolemia and, as the name implies, is caused by natriuresis. Renal salt wasting syndrome rsw is defined as a renal loss of sodium leading to hyponatremia and a decrease in extracellular fluid volume ecv. Cerebral salt wasting following traumatic brain injury in. Formerly, these electrolyte alterations in patients with cerebral disease were ascribed to. This form of hyponatraemia is due to excessive renal sodium. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. In routine clinical practice, distinguishing this condition from the more familiar syndrome. Renal saltwasting syndrome associated with docetaxel in.
Detailed studies revealed normal renal and adrenal function. Renal salt wasting without cerebral wssting you must accept the terms and conditions. We report a case of a 63yearold man with esophageal cancer who developed rsws after docetaxel. Cerebral salt wasting syndrome in children with acute central nervous system injury. Rather, they said, it may occur in the course of any insidious but progressive renal disease. Salt wasting definition of salt wasting by medical. Csw is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine 5. Csws, first described by peters in 1950, is defined as the occurrence of an elevated diuresis and natriuresis after a cerebral injury, leading to hyponatremia and hypovolemia 4. The prevalence of bartters and gitelmans syndrome has been estimated at 1. Cerebral salt wasting csw is an electrolyte imbalance characterized by hyponatremia and hypovolemia. His bp was normal, and there was no evidence of volume depletion.
Nephrotic syndrome chronic kidney disease salt depletion renal sodium losses postobstructive diuresis postacute kidney injury diuresis salt wasting nephropathy lf cerebral salt wasting lf diuretics other renal sodium losses chemotherapyinduced lf extrarenal sodium losses polyuria. Renal salt wasting syndrome in children with intracranial disorders. We intend to briefly discuss the pathophysiology of rsw and siadh, current. Hyponatremia during a severe pneumococcal meningitis with. Secondary hyperaldosteronism occurs as a result of renal salt wasting in both conditions resulting in hypokalaemia and metabolic alkalosis. In summary, treatment with docetaxel may lead to rsws, even in patients with normal renal function. Differentiating the syndrome of inappropriate antidiuretic hormone and csw remains difficult and the pathophysiological mechanisms underlying csw are unclear.
Congenital adrenal hyperplasia genetic and rare diseases. This potentially deleterious response is the result of siadh being a disorder in which renal water handling is impaired but renal sodium handling is normal. Cerebral salt wasting csw is a potential cause of hyponatremia in the setting of. A 51yearold male admitted to the icu for a severe bacterial meningitis who developed, four days later, hyponatremia associated with hypovolemia due to a renal salt wasting. However, csw syndrome is characterized by renal sodium wasting mainly due to increased natriuretic peptides resulting in volume depletion and follows appropriate secretion of avp. Cerebral saltwasting syndrome is a medical entity that leads to hyponatremia and hypovolemia due to dehydration, as a result of an acute or chronic and persistent underlying cns disorder, including trauma, tumors, and other pathologies.
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