Document Detail

Long-term treatment of hyponatremic patients with nephrogenic syndrome of inappropriate antidiuresis: personal experience and review of published case reports.
MedLine Citation:
PMID:  22722264     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a disorder of water balance linked to gain-of-function mutation of arginine vasopressin receptor type 2 (AVPR2) resulting in free water reabsorption and episodes of hyponatremia.
AIMS: To review the long-term treatment of NSIAD.
METHODS: In the first part of this paper, we report 3 cases of male patients presenting with hyponatremia due to NSIAD. The second part consists of a comprehensive review of all published case reports.
RESULTS: In our experience, long-term fluid restriction (FR) and treatment with low doses of urea are efficient and well tolerated. Episodic intake of urea seems sufficient in some patients. Treatment data were available for 13 of the 16 hyponatremic patients reported in the literature. Each of these 13 patients had regulated fluid intake. Six of the patients received urea with no reported failure to correct hyponatremia and 5 received NaCl supplementation with varying efficacy. The AVPR2 antagonists tolvaptan and satavaptan (prescribed before the diagnosis of NSIAD was made) showed no efficacy in 1 patient.
CONCLUSIONS: NSIAD is quite easy to treat with FR and urea in adults as well as in children, with good compliance and efficacy. Of note, FR is well tolerated, suggesting that NSIAD may differ from other causes of syndrome of inappropriate antidiuretic hormone secretion by reduction of thirst intensity due to lower levels of AVP (which stimulates thirst). In eventual refractory cases, furosemide (associated with NaCl supplementation) would represent a valuable therapeutic option by analogy of its efficacy in syndrome of inappropriate antidiuretic hormone secretion.
F Vandergheynst; C Brachet; C Heinrichs; G Decaux
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2012-06-19
Journal Detail:
Title:  Nephron. Clinical practice     Volume:  120     ISSN:  1660-2110     ISO Abbreviation:  Nephron Clin Pract     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-14     Completed Date:  2013-02-11     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  101159763     Medline TA:  Nephron Clin Pract     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  c168-72     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 S. Karger AG, Basel.
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MeSH Terms
Diuretics / therapeutic use
Furosemide / therapeutic use
Genetic Diseases, X-Linked / complications,  therapy*,  urine
Hyponatremia / complications,  therapy*,  urine
Inappropriate ADH Syndrome / complications,  therapy*,  urine
Osmolar Concentration
Sodium Chloride / therapeutic use
Time Factors
Urea / therapeutic use
Water / administration & dosage
Water-Electrolyte Imbalance
Young Adult
Reg. No./Substance:
0/Diuretics; 059QF0KO0R/Water; 7647-14-5/Sodium Chloride; 7LXU5N7ZO5/Furosemide; 8W8T17847W/Urea

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