Viewpoint On

Decaux GT: Low Creatininuria due to Hyponatremia Is Reversible in Many Patients. Nephron DOI 10.1159/000519049

Low urinary creatinine excretion (hypocreatininuria) and low serum creatinine are often observed in euvolemic hyponatremia (due to the syndrome of inappropriate anti-diuretic hormone release; SIADH). This is presumably due to sarcopenia accompanying the state of chronic SIADH. This pathophysiological state is also often accompanied by low solute excretion, which can magnify the effect of a urinary dilution defect on water retention.

In a very nice study, Decaux elaborated on the clinical and biochemical process underlying hypocreatininuria and low solute excretion accompanying acute and chronic euvolemic hyponatremia. Urinary creatinine excretion and solute excretion were measured in patients with hyponatremia early and late, before and after the correction of hyponatremia. This was compared to similar data in normal volunteers with hyponatremia induced by dDAVP administration.

Patients with chronic hyponatremia (>1 month) had marked hypocreatininuria and this reversed after prolonged correction of hyponatremia. Solute excretion followed a similar path. Normal individual with induced acute hyponatremia did not show a reduction in creatinine excretion.

These studies suggest that the changes in creatinine and solute excretion that accompany chronic euvolemic hyponatremia (SIADH) are likely the consequence of muscle loss (sarcopenia) perhaps related to a sedentary lifestyle. They are quite reversible phenomena. Acute hyponatremia has no such effect and the reduction in creatinine excretion is delayed by months after the onset of chronic hyponatremia. The administration or oral urea for treatment of chronic euvolemic hyponatremia (SIADH) confounds the interpretation of the changes in solute excretion.

This very nice study, simple in design and execution, provides a good explanation for the finding of low creatinine excretion in chronic euvolemic hyponatremia.

Quoted Karger Article

Low Creatininuria due to Hyponatremia Is Reversible in Many Patients

Related Posts

Moos RH, Solomon GF. Minnesota multiphasic personality inventory response patterns in patients with rheumatoid arthritis. J Psychosom Res. 1964;8:17-28 George Freeman Solomon was born on 25th November 1931 in Freeport,…

It is well known that prevalent chronic kidney disease (CKD) is associated with excess morbidity and mortality compared to non-CKD. Few studies have examined this association in incident CKD….

Rasmussen AF Jr, Marsh JT, Brill NQ. Increased susceptibility to herpes simplex in mice subjected to avoidance-learning stress or restraint. Proc Soc Exp Biol Med. 1957;96:183-189 Aaron Frederick Rasmussen Jr….