Elevation of Uric Acid Clearance Caused by Inappropriate Antidiuretic Hormone Secretion

Mees, E. J. Dorhout; Assendelft, P Blom van; Nieuwenhuis, M. G.

doi:10.1111/j.0954-6820.1971.tb04340.x

Cited by 75 publications

(22 citation statements)

References 7 publications

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“…We demonstrated the value of determining serum urate levels in hyponatremia and fortified our contention that the persistence of hypouricemia and elevated fractional excretion (FE) of urate after correction of hyponatremia differentiate RSW from SIADH, since the hypouricemia and elevated FEurate in SIADH normalize after correction of the hyponatremia (1,5,(11)(12)(13)(14)(15)(16)(17)(18). Differences in urate metabolism, however, are evident only after correction of the hyponatremia and would not contribute to differentiating SIADH from RSW on first encounter.…”

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confidence: 65%

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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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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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confidence: 65%

“…This has been reviewed in our in-depth review of renal urate transport (11). The V1 receptor activity of ADH is untenable because ADH levels are still elevated when FEurate normalizes with the correction of hyponatremia (16,17,18,35) and induction of SIADH by dDAVP increased FEurate without V1 activity (36).…”

Section: Discussionmentioning

confidence: 99%

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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“…Other factors may also be important. Indirect data suggest that chronicity of hyponatremia affects UA clearance in SIAD by reducing tubular UA reabsorption as a consequence of decreased intracellular anion levels during cell adaptation to hypotonicity (18). Thiazides are also considered to enhance FE-UA by increasing arginine vasopressin (AVP) activity (19,20) or inducing up-regulation of aquaporin-2 expression (21).…”

Section: Discussionmentioning

confidence: 99%

Value of Fractional Uric Acid Excretion in Differential Diagnosis of Hyponatremic Patients on Diuretics

Fenske

Störk

Koschker

et al. 2008

The Journal of Clinical Endocrinology &Amp; Metabolism

151

106

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“…Patients with SIADH had hypouricemia and increased FEurate, which normalized after correction of the hyponatremia. (Dorhout Mees et al, 1971) In 1979 Beck duplicated these findings, but compared serum urate in SIADH with other causes of hyponatremia. Except for only one overlapping value, there was complete separation of serum urate in SIADH from other causes of hyponatremia.…”

Section: Emerging Value Of Determining Feuratementioning

confidence: 99%

Complexity of Differentiating Cerebral-Renal Salt Wasting from SIADH, Emerging Importance of Determining Fractional Urate Excretion

Maesaka¹

2012

Novel Insights on Chronic Kidney Disease, Acute Kidney Injury and Polycystic Kidney Disease

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Elevation of Uric Acid Clearance Caused by Inappropriate Antidiuretic Hormone Secretion

Cited by 75 publications

References 7 publications

More on Renal Salt Wasting Without Cerebral Disease

More on Renal Salt Wasting Without Cerebral Disease

Value of Fractional Uric Acid Excretion in Differential Diagnosis of Hyponatremic Patients on Diuretics

Complexity of Differentiating Cerebral-Renal Salt Wasting from SIADH, Emerging Importance of Determining Fractional Urate Excretion

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