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

Fenske, Wiebke; Störk, Stefan; Koschker, Ann-Cathrin; Blechschmidt, Anne; Lorenz, Daniela; Wortmann, Sebastian; Allolio, Bruno

doi:10.1210/jc.2008-0330

Cited by 151 publications

(117 citation statements)

References 31 publications

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“…Several studies have used test infusions of isotonic saline to discriminate between these alternatives, but because our study was retrospective, we were unable to use this test. 11,20 Some studies have reported that, in patients in a state of volume depletion, volume repletion removes the stimulus for antidiuretic hormone release, allowing excess water to be excreted in a dilute urine and the serum sodium concentration to return toward normal. 21,22 According to this theory, instead of using an isotonic test infusion, we added in our study a criterion of volume depletion in which patients with a sustained increase in serum sodium concentration of !5 mEq/L and a sustained decrease in blood urea nitrogen, even with administration of hypotonic solution, were classified as volume depleted.…”

Section: Discussionmentioning

confidence: 99%

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Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

Miyashita

Shimada

Hunter

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Hyponatremia is associated with pneumonia, and aspiration pneumonia is common in the elderly, however, there has been no study of hyponatremia in this population.OBJECTIVE:To determine the impact of hyponatremia on mortality in elderly patients with aspiration pneumonia, while focusing on the comparison between those with and without the syndrome of inappropriate antidiuresis (SIAD).DESIGN:Retrospective review of existing database and medical records.SETTING:A community teaching hospital in Japan.PATIENTS:Two hundred and twenty‐one elderly patients hospitalized with aspiration pneumonia.MEASUREMENTS:Multivariate logistical regression models were used to compare 30‐day and in‐hospital mortality, in patients with hyponatremia of various severities and etiologies, with that in patients with normal serum sodium concentrations.RESULTS:Sixty‐five (29%) of 221 patients had hyponatremia. Of these 62 (95%) had hypotonic hyponatremia, which were further assessed as having hypovolemic (39 [63%]), hypervolemic (3 [5%]), and euvolemic (20 [32%]) hyponatremia. Of the 20 euvolemic patients, 14 (70%) had SIAD. Both moderate and severe hypotonic hyponatremia were significantly associated with increased in‐hospital mortality (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46–25.0, and OR 5.65, 95% CI 1.14–28.1, respectively). Hyponatremia due to SIAD was significantly associated with both increased 30‐day mortality (OR 7.40, 95% CI 1.73–31.7) and increased in‐hospital mortality (OR 22.3, 95% CI 4.26–117). In contrast, hypovolemic hyponatremia was not significantly associated with increased mortality.CONCLUSIONS:Hyponatremia due to SIAD was strongly associated with increased mortality in elderly patients with aspiration pneumonia, whereas hypovolemic hyponatremia was not associated with increased mortality. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

“…11,12 Clinical Outcomes The primary outcome of analysis was defined as mortality within 30 days of admission (''30-day mortality''). The secondary outcome was defined as mortality during the hospital stay (''in-hospital mortality'').…”

Section: Definition Of Hyponatremia and Its Causesmentioning

confidence: 99%

Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

Miyashita

Shimada

Hunter

et al. 2012

Journal of Hospital Medicine

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“…Elevations of blood urea nitrogen, creatinine, and uric acid level are helpful laboratory clues to the presence of volume depletion. Measuring the urine sodium excretion is considered (it should be <20 to 30 mmol/L) [19,20]. Euvolemic (normovolemic) hyponatremia which is most often associated with the SIADH also known as SchwartzBartter syndrome but can also be seen with primary polydipsia, a low dietary solute intake, renal failure and endocrine disorders such as hypothyroidism and secondary adrenal insufficiency [17,20].…”

Section: Discussionmentioning

confidence: 99%

The role of hyponatremia in preeclampsia

Saridogan¹,

Kırbaş²,

Elmas³

et al. 2017

Med-Science

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Preeclampsia associated hyponatraemia is a quite rare condition that cannot be separated from preeclampsia with severe features completely. This condition may be life-threatening for mothers and fetuses and is needed a multidisciplinary management. A 31-year-old primigravida was referred to our perinatology clinic at 28 weeks 4 days due to preeclampsia. She had nephrotic proteinuria and developed hypervolemic, hypoosmolar, chronic, severe hyponatremia. The pregnant was delivered at 29 weeks of gestation because of severe preeclampsia. The baby died in 48 hours postpartum and maternal hyponatremia improved spontaneously within 72 hours. Studies major on vasopressin about hyponatremia-complicated preeclampsia that its pathogenesis and management is still unclear. Studies that note the importance of vasopressin in the pathogenesis of preeclampsia support the theories and highlight the association of vasopressin and hyponatremia. It is known that the definite treatment is delivery. Maternal outcomes are good but neonatal outcomes are variable.

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“…As the high FeUA usually corrects with fluid restriction in SIADH, some authors have suggested that an FeUA that remains above 10-12% in hyponatremic and hypouricemic patients, a diagnosis other than SIADH should be considered. 83,84 Thus considered it appears that intravascular volume regulates FeUA, with even small increases such as those seen in SIADH being associated with decreased URAT1/OAT activity with increased FeUA, and decreased intravascular volume being associated with increased URAT1/OAT activity and decreased FeUA.…”

Section: Uric Acidmentioning

confidence: 99%

“…Nevertheless, an FeUA above 10-12% remains an excellent tool for the diagnosis of SIADH. 83,84 Similarly, as most of the uromodulin-related diseases (familial juvenile hyperuricemic nephropathy and medullary cystic kidney disease) are associated with reduced FeUA, this can be helpful in diagnosis. 120 …”

Section: Feuamentioning

confidence: 99%

Toward the optimal clinical use of the fraction excretion of solutes in oliguric azotemia

et al. 2010

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While the fractional excretion of solutes have long been considered excellent research tools to investigate tubular physiology, their clinical use has become common over the last 40 years in the diagnoses of many disorders; however, none have reached the clinical utility of the fractional excretion of sodium in the ability to distinguish pre-renal azotemia from acute tubular necrosis. Nevertheless, there are many drugs and medical conditions that interfere with that utility and recently other solutes, including urea, uric acid and lithium, have been recently investigated to improve the diagnostic ability in clinical situations where the fractional excretion of sodium is known to be unreliable. We review the tubular physiology of these solutes and show how the differences in tubular physiology might be exploited to develop a strategy for their optimal clinical use.

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

Abstract: FE-UA allows the diagnosis of SIAD with excellent specificity. Combining the information on U-Na and FE-UA leads to a very high diagnostic accuracy in hyponatremic patients with and without diuretic treatment.

Cited by 151 publications

References 31 publications

Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

The role of hyponatremia in preeclampsia

Toward the optimal clinical use of the fraction excretion of solutes in oliguric azotemia

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