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Renal Salt-Wasting Syndrome


Presentation

  • A male with advanced oropharyngeal cancer is presented in the present report, who was treated with radiotherapy with concurrent administration of cisplatin and who underwent a total of three episodes of severe hyponatremia in the course of therapy.[jstage.jst.go.jp]
  • Genetic abnormalities are carefully presented within the appropriate physiologic context so that readers will understand not only which genes are linked to which diseases but also which pathways lead from a genetic “disturbance” to the systemic appearance[books.google.de]
  • Features that differentiate Bartter and Gitelman syndromes involve renal calcium handling and deposition, serum magnesium, and clinical presentation ( 23 ).[jci.org]
  • Urinary sodium concentration was 85 to 145 mmol/L, fractional excretion of sodium was 1.0% to 8.0%, and urinary osmolar concentration was 340 to 619 mmol/kg, while orthostatic hypotension was present.[annals.org]
  • The present patient developed a sodium-wasting nephropathy after administration of docetaxel for esophageal cancer. Hypovolemic hyponatremia associated with RSWS is also seen in adrenal insufficiency.[link.springer.com]
Weight Loss
  • Thyroid and adrenal functions were normal, there was no edema or body weight loss, and skin turgor was normal.[link.springer.com]
  • In CSW, expect signs and symptoms of dehydration, including dry mucous membranes, poor skin turgor, tachycardia, orthostatic hypotension, weight loss, and a negative fluid balance (with output exceeding intake).[americannursetoday.com]
  • Clinical evaluation revealed signs of volume depletion such as weight loss, decreased skin turgor. His urine output was 4,770 mL (2,650 mL/m 2 ), with approximately 1 L of negative fluid balance.[e-sciencecentral.org]
  • Intravascular volume depletion Historical features suggesting hypovolemia include thirst, abrupt weight loss, decreasing urinary frequency, and negative fluid balance. 11.[slideshare.net]
  • Because of reduced extracellular fluid may have dehydration performance such as low central venous, orthostatic hypotension, tachycardia, dry mucous membrane, jugular vein collapse, body weight loss, et al. [ 7 ].[omicsonline.org]
Severe Pain
  • In January 2011, the patient was admitted to our hospital after initial consultation because of severe pain due to bone metastasis and mediastinal lymph node metastases. He received loxoprofen sodium dehydrate, tramadol, and lansoprazole orally.[link.springer.com]
Salt Craving
  • cravings, dysfunction of the autonomic nervous system (dysautonomia), and dehydration.[en.wikipedia.org]
Hypotension
  • Seven of seventy patients treated with cisplatin over 18 months developed salt-wasting nephropathy and orthostatic hypotension.[annals.org]
  • Look at other dictionaries: Cerebral salt-wasting syndrome — Classification and external resources DiseasesDB 32234 eMedicine ped/354 Cerebral salt wasting syndrome ( … Wikipedia salt depletion syndrome — salt losing syndrome vomiting, dehydration, hypotension[medicine.academic.ru]
  • Its hallmarks are renal excretion of sodium and loss of extracellular fluid volume, producing signs and symptoms of hyponatremia and hypotension.[americannursetoday.com]
  • The largest difference between the two disorders is intravascular volume depletion in CSW (hypotension, decreased skin turgor, elevated hematocrit, possibly increased BUN/serum creatinine ratio) despite a urine sodium concentration that is not low.[seahecim.wordpress.com]
  • The only clue to the presence of CSW rather than SIADH is clinical evidence of extracellular volume depletion, such as hypotension and decreased skin turgor, and/or increased hematocrit 26.[slideshare.net]
Orthostatic Hypotension
  • Seven of seventy patients treated with cisplatin over 18 months developed salt-wasting nephropathy and orthostatic hypotension.[annals.org]
  • Advanced symptoms include muscle cramps, lightheadedness, dizziness or vertigo, feelings of anxiety or panic, increased heart rate or slowed heart rate, low blood pressure and orthostatic hypotension which can result in fainting. [5] Other symptoms frequently[en.wikipedia.org]
  • In CSW, expect signs and symptoms of dehydration, including dry mucous membranes, poor skin turgor, tachycardia, orthostatic hypotension, weight loss, and a negative fluid balance (with output exceeding intake).[americannursetoday.com]
  • Adverse effects reported with short-term use are typically minimal, but may include serious effects such as hypokalaemia, orthostatic hypotension, and unexpectedly rapid serum sodium correction.[jnaccjournal.org]
  • Because of reduced extracellular fluid may have dehydration performance such as low central venous, orthostatic hypotension, tachycardia, dry mucous membrane, jugular vein collapse, body weight loss, et al. [ 7 ].[omicsonline.org]
Quadriplegia
  • Though it is rare, osmotic demyelination is a serious and fatal complication that can cause aggressive neurologic deficit such as seizure, quadriplegia, coma, and even death ( 6 , 47 , 48 ).[frontiersin.org]

Workup

  • Objectives INTRODUCTION Definition PATHOPHYSIOLOGY Etiology EPIDEMIOLOGY History Physical Examination Workup DIAGNOSIS DIFFERENTIAL DIAGNOSIS TREATMENT Prognosis SUMMARY 3.[slideshare.net]
Hyponatremia
  • Hyponatremia after chemotherapy is not an uncommon clinical syndrome.[ncbi.nlm.nih.gov]
  • Other causes of polyuria and hyponatremia should be excluded. Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings.[ncbi.nlm.nih.gov]
  • Abstract Hyponatremia is one of the electrolyte abnormalities frequently encountered in cancer therapy. Cisplatin is a well-known drug which can raise various adverse events, including hyponatremia.[jstage.jst.go.jp]
  • Introduction Hyponatremia, defined by sodium levels of 1 ). Prevalence of hyponatremia is approximately 15–30% in hospitalized patients, both children and adults, and 1–8% in outpatient clinic setting ( 2 ).[frontiersin.org]
  • Introduction Hyponatremia is among the metabolic disturbances oncologists confront in treating patients with malignant disease. Chemotherapy can precipitate or aggravate hyponatremia [ 1 , 2 ].[link.springer.com]

Treatment

  • The treatment for RSWS is supplement of salt, which is opposite to the treatment of SIADH. We report a case of a patient with hyponatremia and excessive urinary excretion of sodium after cisplatin-based chemotherapy.[ncbi.nlm.nih.gov]
  • Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings. Prognosis is excellent, as recovery was the rule in all the reported cases.[ncbi.nlm.nih.gov]
  • The treatment for RSWS is supplement of salt, which is opposite to the treatment of SIADH. We report a case of a patient with hyponatremia and excessive urinary excretion of sodium after cisplatin -based chemotherapy.[journals.lww.com]
  • Simple fluid restriction is recommended for the treatment of hyponatremia in uncomplicated SIADH ( 11 , 49 ).[frontiersin.org]
  • Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings.[utsouthwestern.influuent.utsystem.edu]

Prognosis

  • Prognosis is excellent, as recovery was the rule in all the reported cases.[ncbi.nlm.nih.gov]
  • Objectives INTRODUCTION Definition PATHOPHYSIOLOGY Etiology EPIDEMIOLOGY History Physical Examination Workup DIAGNOSIS DIFFERENTIAL DIAGNOSIS TREATMENT Prognosis SUMMARY 3.[slideshare.net]
  • Alvarez et al. 1996 Blood levels of histamine, IL-1β, and TNF-α in patients with mild to moderate alzheimer disease Follo et al. 1994 Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis[google.com]
  • As long as accurate and timely diagnosis, appropriate treatment, the prognosis is good. About CSWS pathogenesis remains to be further studied.[omicsonline.org]

Etiology

  • Finally, inappropriate ADH secretion can occur as a result of renal, adrenal, or thyroid dysfunction, and so those etiologies should be ruled out if suspected.[docneuro.com]
  • Objectives INTRODUCTION Definition PATHOPHYSIOLOGY Etiology EPIDEMIOLOGY History Physical Examination Workup DIAGNOSIS DIFFERENTIAL DIAGNOSIS TREATMENT Prognosis SUMMARY 3.[slideshare.net]
  • Ongoing controversies regarding etiology, diagnosis, treatment The existence of CSW as a clinical entity distinct from SIADH is somewhat controversial.[clinicaladvisor.com]
  • ITD Risk classification a) High risk High risk High risk Conditioning drugs Busulfan, Fludarabine, ATG Cyclophosphamide, ATG Busulfan, Fludarabine, ATG TBI (cGy) Not done b) 1,320 Not done Immunosuppression c) Yes Yes Yes Onset of fever (PTD) 30 1 18 Etiology[e-sciencecentral.org]

Epidemiology

  • Objectives INTRODUCTION Definition PATHOPHYSIOLOGY Etiology EPIDEMIOLOGY History Physical Examination Workup DIAGNOSIS DIFFERENTIAL DIAGNOSIS TREATMENT Prognosis SUMMARY 3.[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • More than 2,000 disease genes have been identified in the last 20 years, providing important new insight into the pathophysiology of diseases in every field of medicine.[books.google.de]
  • However, an exact value and pathophysiologic mechanisms of decreased serum uric acid level in pediatric patients remain elusive.[frontiersin.org]
  • PATHOPHYSIOLOGY The SNS promotes Na , uric acid &water reabsorption in the proximal tubule, as well as renin release.[slideshare.net]
  • "Cerebral salt wasting: pathophysiology, diagnosis, and treatment". Neurosurg Clin N Am. 21 (2): 339–52. doi : 10.1016/j.nec.2009.10.011. PMID 20380974. Peters JP, Welt LG, Sims EA, Orloff J, Needham J (1950).[en.wikipedia.org]

Prevention

  • In the mouse, inactivation of alphaENaC results in failure to clear fetal lung liquid at birth and in early neonatal death, preventing the observation of a PHA-1 renal phenotype.[ncbi.nlm.nih.gov]
  • Adequate hydration was ensured by administration of 2–3 L fluid per day for 3 days prior to nedaplatin administration to prevent nephrotoxicity.[link.springer.com]
  • Close monitoring of hypertonic saline is essential to prevent overly rapid correction of hyponatraemia, which might result in osmotic myelinolysis.[edmcasereports.com]
  • In addition, increased natriuretic peptides induce natriuresis by increasing GFR and preventing sodium reabsorption in the collecting duct ( 28 , 29 ).[frontiersin.org]
  • No specific treatment options exist, so the goal is prevention, which is best accomplished through the slow correction of the serum sodium.[clinicaladvisor.com]

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