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Zhao Y, Peng X, Wang Q, Zhang Z, Wang L, Xu Y, Yang H, Bai J, Geng D. Crosstalk Between the Neuroendocrine System and Bone Homeostasis. Endocr Rev 2024; 45:95-124. [PMID: 37459436 DOI: 10.1210/endrev/bnad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Indexed: 01/05/2024]
Abstract
The homeostasis of bone microenvironment is the foundation of bone health and comprises 2 concerted events: bone formation by osteoblasts and bone resorption by osteoclasts. In the early 21st century, leptin, an adipocytes-derived hormone, was found to affect bone homeostasis through hypothalamic relay and the sympathetic nervous system, involving neurotransmitters like serotonin and norepinephrine. This discovery has provided a new perspective regarding the synergistic effects of endocrine and nervous systems on skeletal homeostasis. Since then, more studies have been conducted, gradually uncovering the complex neuroendocrine regulation underlying bone homeostasis. Intriguingly, bone is also considered as an endocrine organ that can produce regulatory factors that in turn exert effects on neuroendocrine activities. After decades of exploration into bone regulation mechanisms, separate bioactive factors have been extensively investigated, whereas few studies have systematically shown a global view of bone homeostasis regulation. Therefore, we summarized the previously studied regulatory patterns from the nervous system and endocrine system to bone. This review will provide readers with a panoramic view of the intimate relationship between the neuroendocrine system and bone, compensating for the current understanding of the regulation patterns of bone homeostasis, and probably developing new therapeutic strategies for its related disorders.
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Affiliation(s)
- Yuhu Zhao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
| | - Xiaole Peng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
| | - Qing Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
| | - Zhiyu Zhang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Liangliang Wang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei 230022, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University; Orthopedics Institute, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
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Radvanyi Z, Yoo EJ, Kandasamy P, Salas-Bastos A, Monnerat S, Refardt J, Christ-Crain M, Hayashi H, Kondo Y, Jantsch J, Rubio-Aliaga I, Sommer L, Wagner CA, Hediger MA, Kwon HM, Loffing J, Pathare G. Extracellular sodium regulates fibroblast growth factor 23 (FGF23) formation. J Biol Chem 2024; 300:105480. [PMID: 37992803 PMCID: PMC10770535 DOI: 10.1016/j.jbc.2023.105480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
The bone-derived hormone fibroblast growth factor-23 (FGF23) has recently received much attention due to its association with chronic kidney disease and cardiovascular disease progression. Extracellular sodium concentration ([Na+]) plays a significant role in bone metabolism. Hyponatremia (lower serum [Na+]) has recently been shown to be independently associated with FGF23 levels in patients with chronic systolic heart failure. However, nothing is known about the direct impact of [Na+] on FGF23 production. Here, we show that an elevated [Na+] (+20 mM) suppressed FGF23 formation, whereas low [Na+] (-20 mM) increased FGF23 synthesis in the osteoblast-like cell lines UMR-106 and MC3T3-E1. Similar bidirectional changes in FGF23 abundance were observed when osmolality was altered by mannitol but not by urea, suggesting a role of tonicity in FGF23 formation. Moreover, these changes in FGF23 were inversely proportional to the expression of NFAT5 (nuclear factor of activated T cells-5), a transcription factor responsible for tonicity-mediated cellular adaptations. Furthermore, arginine vasopressin, which is often responsible for hyponatremia, did not affect FGF23 production. Next, we performed a comprehensive and unbiased RNA-seq analysis of UMR-106 cells exposed to low versus high [Na+], which revealed several novel genes involved in cellular adaptation to altered tonicity. Additional analysis of cells with Crisp-Cas9-mediated NFAT5 deletion indicated that NFAT5 controls numerous genes associated with FGF23 synthesis, thereby confirming its role in [Na+]-mediated FGF23 regulation. In line with these in vitro observations, we found that hyponatremia patients have higher FGF23 levels. Our results suggest that [Na+] is a critical regulator of FGF23 synthesis.
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Affiliation(s)
- Zsuzsa Radvanyi
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland
| | - Eun Jin Yoo
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Palanivel Kandasamy
- Membrane Transport Discovery Lab, Department of Nephrology and Hypertension and Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | | | - Sophie Monnerat
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Himeka Hayashi
- Department of Animal Sciences, Teikyo University of Science, Yamanashi, Japan
| | - Yasuhiko Kondo
- Department of Animal Sciences, Teikyo University of Science, Yamanashi, Japan
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg and University of Regensburg, Regensburg, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Isabel Rubio-Aliaga
- Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Lukas Sommer
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Carsten A Wagner
- Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Matthias A Hediger
- Membrane Transport Discovery Lab, Department of Nephrology and Hypertension and Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Hyug Moo Kwon
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Johannes Loffing
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland
| | - Ganesh Pathare
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland.
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Tzoulis P, Yavropoulou MP. Association of hyponatremia with bone mineral density and fractures: a narrative review. Ther Adv Endocrinol Metab 2023; 14:20420188231197921. [PMID: 37736657 PMCID: PMC10510353 DOI: 10.1177/20420188231197921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: 'hyponatremia' or 'sodium' or 'SIADH' and 'fractures' or 'bone' or 'osteoporosis', as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.
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Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London Medical School, Gower Street, London, WC1E6BT, UK
| | - Maria P. Yavropoulou
- Department of Propaedeutic and Internal Medicine, Medical School of University of Athens, Endocrinology Unit, Athens, Attica, Greece
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Zhu Q, Xiao L, Cheng G, He J, Yin C, Wang L, Wang Q, Li L, Wei B, Weng Y, Geng F, Shen XZ, Shi P. Self-maintaining macrophages within the kidney contribute to salt and water balance by modulating kidney sympathetic nerve activity. Kidney Int 2023:S0085-2538(23)00343-5. [PMID: 37224917 DOI: 10.1016/j.kint.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
The kidney is critical in controlling salt and water balance, with the interstitium involved with a variety of components including immune cells in steady state. However, the roles of resident immune cells in kidney physiology are largely unknown. To help unravel some of these unknowns, we employed cell fate mapping, and identified a population of embryo-derived self-maintaining macrophages (SM-MØ) that were independent of the bone marrow in adult mouse kidneys. This kidney-specific SM-MØ population was distinctive from the kidney monocyte-derived macrophages in transcriptome and in their distribution. Specifically, the SM-MØ highly expressed nerve-associated genes; high-resolution confocal microscopy revealed that the SM-MØ in the cortex were in close association with sympathetic nerves and there was a dynamical interaction between macrophages and sympathetic nerves when live kidney sections were monitored. Kidney-specific depletion of the SM-MØ resulted in reduced sympathetic distribution and tone, leading to reduced renin secretion, increased glomerular filtration rate and solute diuresis, which caused salt decompensation and significant weight loss under a low-salt diet challenge. Supplementation of L-3,4-dihydroxyphenylserine which is converted to norepinephrine in vivo rescued the phenotype of SM-MØ-depleted mice. Thus, our findings provide insights in kidney macrophage heterogeneity and address a non-canonical role of macrophages in kidney physiology. In contrast to the well-appreciated way of central regulation, local regulation of sympathetic nerve distribution and activities in the kidney was uncovered.
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Affiliation(s)
- Qian Zhu
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liang Xiao
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guo Cheng
- Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian He
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chunyou Yin
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liang Wang
- Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Department of Laboratory Medicine, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Li
- Department of Pharmacy, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Wei
- Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuancheng Weng
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Geng
- Department of Blood of Transfusion, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao Z Shen
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;.
| | - Peng Shi
- Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;; Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;.
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Analysis of the Chemical Composition and Morphological Characterization of Tissue Osseointegrated to a Dental Implant after 5 Years of Function. Int J Mol Sci 2022; 23:ijms23168882. [PMID: 36012148 PMCID: PMC9408532 DOI: 10.3390/ijms23168882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Osseointegration implies the coexistence of a biocompatible implant subjected to masticatory loads and living bone tissue adhered to its surface; this interaction is a critical process for the success of implants. The objective of this work is to analyze the osseoformation and osseointegration of a dental implant in operation for 5 years microscopically through morphological analysis of the surface and chemical composition through a variable pressure scanning electron microscope (VP-SEM) and energy dispersive X-ray spectrometry (EDX). The chemical composition and general characteristics of the structural morphology of random areas of the surfaces of an osseointegrated dental implant from an ex vivo sample were analyzed. On the surface of the implant free of bone tissue, titanium (TI) was mainly identified in the area of the implant threads and carbon (C) in the depth of the implant threads. Phosphorus (P), calcium (Ca), oxygen (O), carbon (C), with dense and homogeneous distribution, and, to a lesser extent, sodium (Na) were detected on the bone surface around the contour of the implant. Regarding the morphological characteristics of the implant surface, a rough structure with some irregularities and detachments of the implant lodged in the bone tissue was observed. Microscopic analysis showed calcified bone tissue distributed in an orderly manner on the coronal and medial surface and sinuous and irregular in the apical area, with the presence of red blood cells. The composition of the implant allows a dynamic process of bone remodeling and regeneration subject to the biological and mechanical needs of the operation. Dental implants are shown to have exceptional and long-lasting biocompatibility that enables the formation of mature peri-implant bone tissue.
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Miazgowski T, Rył A, Szylińska A, Rotter I. The Impact of Major and Trace Elements in Serum and Bone on Dual-Energy X-Ray Absorptiometry-Derived Hip Strength. Calcif Tissue Int 2022; 110:674-684. [PMID: 35072733 PMCID: PMC9108102 DOI: 10.1007/s00223-022-00945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to establish associations between both serum levels and bone content of a wide range of elements (Na, K, P, Ca, Mg, Zn, Cu, Cr, Mn, Fe, and Pb), with hip strength (HS) indices derived from dual-energy X-ray absorptiometry (DXA). The study population consisted of a number of male patients aged 56-77 years following hip replacement due to osteoarthritis of the hip. Bone specimens were taken from the femoral head and neck during arthroplasty. The elemental analyses were carried out using coupled plasma optical emission spectrometry. The following DXA-HS parameters were assessed: buckling ratio (BR), cross-sectional area (CSA) and its moment of inertia (CSMI), section modulus, and Femoral Strength Index (FSI). Age was positively correlated with Na, K, and Cu in the bone. Ca in the bone was positively associated with BR and negatively with SM and CSMI. Of all the DXA-HS parameters, the weakest associations of elements in the bone were found with FSI and the strongest with BR. Among the elements in the serum, the strongest negative associations were found for K, Cr, Mn, and Zn with CSA, while the majority of bone elements were associated either positively (Ca, P, Mg, Zn, and Cu) or negatively (Mn, Fe, Pb, and Cr) with BR. In conclusion, the interactions between individual elements in blood serum and bone with DXA-HS could not be unequivocally established.
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Affiliation(s)
- Tomasz Miazgowski
- Department of Propedeutics of Internal Medicine and Arterial Hypertension, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland.
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Huang HY, Huang ZQ, Hua LY, Liu WS, Xu F, Ge XQ, Lu CF, Su JB, Wang XQ. The association between normal serum sodium levels and bone turnover in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13:927223. [PMID: 36387923 PMCID: PMC9646934 DOI: 10.3389/fendo.2022.927223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sodium is a critically important component of bones, and hyponatremia has firmly been established as a risk factor associated with the incidence of fragility fractures. However, researches have also revealed that lower serum sodium are linked to reductions in muscle mass and a higher risk of cardiovascular disease even when these levels are within the normal range. Accordingly, this study was developed to examine the relationships between normal serum sodium concentrations and bone turnover in patients with type 2 diabetes (T2D). METHODS Patients with T2D were enrolled in the present study from January 2021 to April 2022. All patients underwent analyses of serum sodium levels, oral glucose tolerance testing (OGTT), bone turnover markers (BTMs), and dual-energy X-ray absorptiometry (DXA) scanning. BTMs included bone formation markers osteocalcin (OC) and N-terminal propeptide of type-I procollagen (PINP), and bone resorption marker C-terminal telopeptide (CTx). Patients were stratified into three subgroups based on the tertiles of their serum sodium concentrations. RESULTS In total, 372 patients with T2D and sodium levels in the normal range were enrolled in this study. Serum OC and PINP levels were increased from subgroup with the low sodium tertile to that with the high sodium tertile (p for trend < 0.05), whereas CTx level was comparable among the subgroups. A positive correlation was detected between serum sodium levels and both lnOC (r = 0.210, p < 0.001) and lnPINP (r = 0.196, p < 0.001), with these relationships remaining significant even following adjustment for age, sex, body mass index (BMI), and HbA1c. Only after adjusting for these four factors a positive correlation was detected between serum sodium levels and CTx levels (r = 0.108, p < 0.05). Linear regression analyses revealed that following adjustment for potential covariates, serum sodium level was and positively significantly associated with lnOC level (β = 0.134, t = 2.281, p < 0.05) and PINP level (β = 0.179, t = 3.023, p < 0.01). CONCLUSION These results highlight a significant association between low-normal serum sodium levels and low bone turnover.
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Affiliation(s)
- Hai-yan Huang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Zhi-qi Huang
- Department of General Surgery, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Ling-yan Hua
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Wang-shu Liu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Feng Xu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Xiao-qin Ge
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Chun-feng Lu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Jian-bin Su, ; Xue-qin Wang,
| | - Jian-bin Su
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Jian-bin Su, ; Xue-qin Wang,
| | - Xue-qin Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Jian-bin Su, ; Xue-qin Wang,
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Dong B, Lv R, Wang J, Che L, Wang Z, Huai Z, Wang Y, Xu L. The Extraglycemic Effect of SGLT-2is on Mineral and Bone Metabolism and Bone Fracture. Front Endocrinol (Lausanne) 2022; 13:918350. [PMID: 35872985 PMCID: PMC9302585 DOI: 10.3389/fendo.2022.918350] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a risk factor for osteoporosis. The effects of T2DM and anti-diabetic agents on bone and mineral metabolism have been observed. Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) promote urinary glucose excretion, reduce blood glucose level, and improve the cardiovascular and diabetic nephropathy outcomes. In this review, we focused on the extraglycemic effect and physiological regulation of SGLT-2is on bone and mineral metabolism. SGLT-2is affect the bone turnover, microarchitecture, and bone strength indirectly. Clinical evidence of a meta-analysis showed that SGLT-2is might not increase the risk of bone fracture. The effect of SGLT-2is on bone fracture is controversial, and further investigation from a real-world study is needed. Based on its significant benefit on cardiovascular and chronic kidney disease (CKD) outcomes, SGLT-2is are an outstanding choice. Bone mineral density (BMD) and fracture risk evaluation should be considered for patients with a high risk of bone fracture.
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Affiliation(s)
- Bingzi Dong
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ruolin Lv
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Che
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongchao Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhouyang Huai
- Department of Geriatric Medicine, Yantai Yuhuangding Hospital Affiliated Hospital of Qingdao University, Yantai, China
| | - Yangang Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Lili Xu, ; Yangang Wang,
| | - Lili Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Lili Xu, ; Yangang Wang,
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Machine Learning Consensus Clustering of Hospitalized Patients with Admission Hyponatremia. Diseases 2021; 9:diseases9030054. [PMID: 34449583 PMCID: PMC8395840 DOI: 10.3390/diseases9030054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/12/2023] Open
Abstract
Background: The objective of this study was to characterize patients with hyponatremia at hospital admission into clusters using an unsupervised machine learning approach, and to evaluate the short- and long-term mortality risk among these distinct clusters. Methods: We performed consensus cluster analysis based on demographic information, principal diagnoses, comorbidities, and laboratory data among 11,099 hospitalized adult hyponatremia patients with an admission serum sodium below 135 mEq/L. The standardized mean difference was utilized to identify each cluster’s key features. We assessed the association of each hyponatremia cluster with hospital and one-year mortality using logistic and Cox proportional hazard analysis, respectively. Results: There were three distinct clusters of hyponatremia patients: 2033 (18%) in cluster 1, 3064 (28%) in cluster 2, and 6002 (54%) in cluster 3. Among these three distinct clusters, clusters 3 patients were the youngest, had lowest comorbidity burden, and highest kidney function. Cluster 1 patients were more likely to be admitted for genitourinary disease, and have diabetes and end-stage kidney disease. Cluster 1 patients had the lowest kidney function, serum bicarbonate, and hemoglobin, but highest serum potassium and prevalence of acute kidney injury. In contrast, cluster 2 patients were the oldest and were more likely to be admitted for respiratory disease, have coronary artery disease, congestive heart failure, stroke, and chronic obstructive pulmonary disease. Cluster 2 patients had lowest serum sodium and serum chloride, but highest serum bicarbonate. Cluster 1 patients had the highest hospital mortality and one-year mortality, followed by cluster 2 and cluster 3, respectively. Conclusion: We identified three clinically distinct phenotypes with differing mortality risks in a heterogeneous cohort of hospitalized hyponatremic patients using an unsupervised machine learning approach.
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Khan MH, Walsh JJ, Mihailović JM, Mishra SK, Coman D, Hyder F. Imaging the transmembrane and transendothelial sodium gradients in gliomas. Sci Rep 2021; 11:6710. [PMID: 33758290 PMCID: PMC7987982 DOI: 10.1038/s41598-021-85925-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
Under normal conditions, high sodium (Na+) in extracellular (Na+e) and blood (Na+b) compartments and low Na+ in intracellular milieu (Na+i) produce strong transmembrane (ΔNa+mem) and weak transendothelial (ΔNa+end) gradients respectively, and these manifest the cell membrane potential (Vm) as well as blood–brain barrier (BBB) integrity. We developed a sodium (23Na) magnetic resonance spectroscopic imaging (MRSI) method using an intravenously-administered paramagnetic polyanionic agent to measure ΔNa+mem and ΔNa+end. In vitro 23Na-MRSI established that the 23Na signal is intensely shifted by the agent compared to other biological factors (e.g., pH and temperature). In vivo 23Na-MRSI showed Na+i remained unshifted and Na+b was more shifted than Na+e, and these together revealed weakened ΔNa+mem and enhanced ΔNa+end in rat gliomas (vs. normal tissue). Compared to normal tissue, RG2 and U87 tumors maintained weakened ΔNa+mem (i.e., depolarized Vm) implying an aggressive state for proliferation, whereas RG2 tumors displayed elevated ∆Na+end suggesting altered BBB integrity. We anticipate that 23Na-MRSI will allow biomedical explorations of perturbed Na+ homeostasis in vivo.
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Affiliation(s)
- Muhammad H Khan
- Department of Biomedical Engineering, Yale University, N143 TAC (MRRC), 300 Cedar Street, New Haven, CT, 06520, USA.
| | - John J Walsh
- Department of Biomedical Engineering, Yale University, N143 TAC (MRRC), 300 Cedar Street, New Haven, CT, 06520, USA
| | - Jelena M Mihailović
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
| | - Sandeep K Mishra
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
| | - Fahmeed Hyder
- Department of Biomedical Engineering, Yale University, N143 TAC (MRRC), 300 Cedar Street, New Haven, CT, 06520, USA. .,Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA.
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11
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Lana A, Struijk EA, Ortolá R, Rodríguez-Artalejo F, Lopez-Garcia E. Longitudinal Association Between Sodium and Potassium Intake and Physical Performance in Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:2379-2386. [PMID: 32009144 DOI: 10.1093/gerona/glaa031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Aging is associated with a progressive difficulty to maintain ion regulation, which might impair the capacity for muscle contraction. Thus, the aim of this study was to examine the association between 5-year changes in dietary intake of sodium and potassium and changes in physical performance among older adults. METHODS We performed a prospective study with 868 participants from the Seniors-ENRICA cohort. Diet was measured with a validated diet history and physical performance was measured with the Short Physical Performance Battery (SPPB), both in 2012 and 2017. Analyses were performed with linear regression models adjusted for sociodemographic variables, lifestyle, and morbidity, using changes in the intake of sodium and potassium and changes in the sodium/potassium ratio during follow-up as independent variables, and the continuous change in the SPPB score as the dependent variable. RESULTS Over 5 years of follow-up, a 1 SD increase in sodium intake (ie, 0.73 g/d) was associated with a 0.13 (95% confidence interval [CI]: 0.26-0.01) points reduction in the SPPB score, while a 1 SD increase in potassium intake (ie, 0.70 g/d) was associated with a 0.19 (0.05-0.34) points increment in the score. In addition, a 1 SD increase in the sodium-to-potassium ratio (ie, 0.30) was associated with worse SPPB (-0.58 [-0.95 to -0.21]). Participants who adhered to dietary recommendations for minerals at baseline but became noncompliant during follow-up decreased their result in the SPPB. CONCLUSION An increase of dietary sodium intake, a decrease of potassium intake and the resulting increment in the sodium-to-potassium ratio were prospectively associated with worse physical performance in older adults.
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Affiliation(s)
- Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences, Universidad de Oviedo/ISPA, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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12
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Abstract
INTRODUCTION Preclinical, clinical, and population-based studies have provided evidence that anti-diabetic drugs affect bone metabolism and may affect the risk of fracture in diabetic patients. AREAS COVERED An overview of the skeletal effects of anti-diabetic drugs used in type 2 diabetes is provided. Searches on AdisInsight, PubMed, and Medline databases were conducted up to 1st July 2020. The latest evidence from randomized clinical trials and population-based studies on the skeletal safety of the most recent drugs (DPP-4i, GLP-1RA, and SGLT-2i) is provided. EXPERT OPINION Diabetic patients present with a higher risk of fracture for a given bone mineral density suggesting a role of bone quality in the etiology of diabetic fracture. Bone quality is difficult to assess in human clinical practice and the use of preclinical models provides valuable information on diabetic bone alterations. As several links have been established between bone and energy homeostasis, it is interesting to study the safety of anti-diabetic drugs on the skeleton. So far, evidence for the newest molecules suggests a neutral fracture risk, but further studies, especially in different types of patient populations (patients at risk or with history of cardiovascular disease, renal impairment, neuropathy) are required to fully appreciate this matter.
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Affiliation(s)
- Guillaume Mabilleau
- Groupe Etude Remodelage Osseux et biomatériaux, GEROM, UPRES EA 4658, UNIV Angers, SFR ICAT 4208, Institut de Biologie en Santé , Angers, France
- Service Commun d'Imagerie et Analyses Microscopiques, SCIAM, UNIV Angers, SFR ICAT 4208, Institut de Biologie en Santé , Angers, France
- Bone pathology unit, Angers University hospital , Angers Cedex, France
| | - Béatrice Bouvard
- Groupe Etude Remodelage Osseux et biomatériaux, GEROM, UPRES EA 4658, UNIV Angers, SFR ICAT 4208, Institut de Biologie en Santé , Angers, France
- Rheumatology department, Angers University Hospital , Angers Cedex, France
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13
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Auer MK, Paizoni L, Hofbauer LC, Rauner M, Chen Y, Schmidt H, Huebner A, Bidlingmaier M, Reisch N. Effects of androgen excess and glucocorticoid exposure on bone health in adult patients with 21-hydroxylase deficiency. J Steroid Biochem Mol Biol 2020; 204:105734. [PMID: 32784048 DOI: 10.1016/j.jsbmb.2020.105734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT This study aimed to determine the role of modifiable predictors on bone health in congenital adrenal hyperplasia (CAH). DESIGN Cross-sectional, single center study, including 97 patients (N = 42 men) with classic CAH due to 21-hydroxylase deficiency (N = 65 salt wasting, N = 32 simple virilizing). MAIN OUTCOME MEASURES Treatment-related predictors of bone health. RESULTS Average T scores (-0.9 ± 1.4 vs. -0.4 ± 1.4; p = 0.036) as well as Z scores (-1.0 ± 1.3 vs. -0.1 ± 1.4; p = 0.012) at the spine in patients with CAH were significantly lower in men than women. While osteoporosis was rare in women, it was documented in 9.1% of men with CAH. There was a significant positive correlation of Z scores at the spine with advancing age in women with CAH (R² = 0.178; p = 0.003). In multivariate analysis, the intake of conventional hydrocortisone (HC) instead of synthetic glucocorticoids was independently associated with a higher bone mineral density (BMD) at the hip region in both sexes. In women, there was a positive association with vitamin D concentrations. Interestingly, higher sodium levels were associated with a lower BMD independent of renin levels and fludrocortisone dosage. Neither in men nor in women, markers of androgen control were predictive for BMD at any site. Markers of bone turnover indicated low bone turnover. No pathological fractures were documented. CONCLUSIONS Men with CAH are particularly prone to low bone density, while women seem to be relatively protected by androgen excess compared to the general female population. The use of HC instead of synthetic GCs for hormone replacement may translate into better bone health.
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Affiliation(s)
- Matthias K Auer
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Luisa Paizoni
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Lorenz C Hofbauer
- Division of Endocrinology and Diabetes, Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Division of Endocrinology and Diabetes, Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Yiqing Chen
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Heinrich Schmidt
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Klinikum der Universität München, LMU München, Munich, Germany
| | - Angela Huebner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany.
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14
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Schröder A, Neubert P, Titze J, Bozec A, Neuhofer W, Proff P, Kirschneck C, Jantsch J. Osteoprotective action of low-salt diet requires myeloid cell-derived NFAT5. JCI Insight 2019; 4:127868. [PMID: 31801906 DOI: 10.1172/jci.insight.127868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Dietary salt consumption leads to cutaneous Na+ storage and is associated with various disorders, including osteopenia. Here, we explore the impact of Na+ and the osmoprotective transcription factor nuclear factor of activated T cell 5 (NFAT5) on bone density and osteoclastogenesis. Compared with treatment of mice with high-salt diet, low-salt diet (LSD) increased bone density, decreased osteoclast numbers, and elevated Na+ content and Nfat5 levels in the BM. This response to LSD was dependent on NFAT5 expressed in myeloid cells. Simulating in vivo findings, we exposed osteoclast precursors and osteoblasts to elevated Na+ content (high-salt conditions; HS¢), resulting in increased NFAT5 binding to the promotor region of RANKL decoy receptor osteoprotegerin (OPG). These data not only demonstrate that NFAT5 in myeloid cells determines the Na+ content in BM, but that NFAT5 is able to govern the expression of the osteoprotective gene OPG. This provides insights into mechanisms of Na+-induced cessation of osteoclastogenesis and offers potentially new targets for treating salt-induced osteopenia.
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Affiliation(s)
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Jens Titze
- Duke-National University of Singapore, Singapore
| | - Aline Bozec
- Department of Internal Medicine, FAU Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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15
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Diemar SS, Sejling AS, Eiken P, Suetta C, Jørgensen NR, Andersen NB. Hyponatremia and metabolic bone disease in patients with epilepsy: A cross-sectional study. Bone 2019; 123:67-75. [PMID: 30905745 DOI: 10.1016/j.bone.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
AIM Patients with epilepsy frequently develop hyponatremia due to the treatment with antiepileptic drugs and have an increased risk of developing metabolic bone disease. Hyponatremia is known to be associated with osteoporosis. The aim of the study was to investigate the association between hyponatremia and osteoporosis in patients with epilepsy. METHOD AND MATERIAL This cross-sectional study included patients with epilepsy from a tertiary epilepsy out-patient clinic in Denmark, who had a Dual Energy X-ray Absorptiometry scan performed and an accompanying plasma sodium (p-Na) measured prior to or a maximum of 14 days after the scan. Information regarding the patients' health and medical conditions were obtained from their medical reports. RESULTS A total of 695 patients (females 53.8%, age 49 (34:63) years (median (quartiles)) were included. 10.4% had hyponatremia (p-Na ≤ 135 mmol/L). The hyponatremic patients had significantly lower T-scores in the lumbar spine, femoral neck and total femur (all p < 0.023) and the odds ratio of osteoporosis (T-score < -2.5) was significantly increased (2.91 (1.61-5.27) (95% confidence interval) (p = 0.001)). When adjusting for potential confounders the patients with moderate and severe hyponatremia (p-Na < 129 mmol/L) had a significantly lower mean T-score in the lumbar spine (p = 0.030). CONCLUSION We conclude that hyponatremia is common in patients with epilepsy and that moderate and severe hyponatremia is independently associated with decreased bone mineral density in the lumbar spine. Therefore, hyponatremia in a patient with epilepsy should warrant further examination of the patient for bone loss and osteoporosis.
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Affiliation(s)
- Sarah Seberg Diemar
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense, C, Denmark.
| | - Anne-Sophie Sejling
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Charlotte Suetta
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Geriatric Research Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2720 Herlev, Denmark; Geriatric Department, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsensvej 7, 2400 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Niklas Rye Jørgensen
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense, C, Denmark; Department of Clinical Biochemistry, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Noémi Becser Andersen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
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16
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Murthy K, Ondrey GJ, Malkani N, Raman G, Hodge MB, Marcantonio AJ, Verbalis JG. THE EFFECTS OF HYPONATREMIA ON BONE DENSITY AND FRACTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Endocr Pract 2019; 25:366-378. [PMID: 30720342 DOI: 10.4158/ep-2018-0499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: Hyponatremia decreases bone mineral density and is a major risk factor for fragility fractures. Objectives of our systematic review and meta-analysis were to analyze the overall effects of hyponatremia on bone fractures, osteoporosis, and mortality. Methods: We extracted data from Medline, Cochrane Central, and EMBASE 1960-2017 and conference abstracts from 2007-2017. We included studies with data on serum sodium, fractures, bone density, or diagnoses of osteoporosis. Studies were independently reviewed by two authors and assessed for bias using the Newcastle-Ottawa scale. Random effect models meta-analysis was used when at least three studies reported the same outcome measures. We reported summary odds ratios (ORs) and 95% confidence intervals (CIs). Results: We included 26 studies for qualitative analysis. Fifteen studies were included in the meta-analysis to evaluate the effects of hyponatremia on fractures, four studies for bone mineral density changes, and six for mortality. Hyponatremia increased the odds of fractures at all sites (summary OR, 2.34 [95% CI, 1.86, 2.96]. There was an increase in the odds of osteoporosis (summary OR, 2.67 [95% CI, 2.07, 3.43]). Mortality risk among the included studies remained high (summary OR, 1.31 [95% CI, 1.16, 1.47]). Conclusion: Our meta-analysis confirms a statistically significant association of hyponatremia with bone fractures and osteoporosis along with higher mortality. Long-term prospective studies evaluating the impact of correcting hyponatremia on bone health, fractures, and mortality are required. Abbreviations: AVP = arginine vasopressin; CI = confidence interval; CKD = chronic kidney disease; OR = odds ratio; SIADH = syndrome of inappropriate antidiuretic hormone.
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17
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Portales-Castillo I, Sterns RH. Allostasis and the Clinical Manifestations of Mild to Moderate Chronic Hyponatremia: No Good Adaptation Goes Unpunished. Am J Kidney Dis 2018; 73:391-399. [PMID: 30554800 DOI: 10.1053/j.ajkd.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/14/2018] [Indexed: 01/01/2023]
Abstract
When homeostatic regulatory systems are unable to maintain a normal serum sodium concentration, the organism must adapt to demands of a disordered internal environment, a process known as "allostasis." Human cells respond to osmotic stress created by an abnormal serum sodium level with the same adaptations used by invertebrate organisms that do not regulate body fluid osmolality. To avoid intolerable changes in their volume, cells export organic osmolytes when exposed to a low serum sodium concentration and accumulate these intracellular solutes when serum sodium concentration increases. The brain's adaptation to severe hyponatremia (serum sodium < 120 mEq/L) has been studied extensively. However, adaptive responses occur with less severe hyponatremia and other tissues are affected; the consequences of these adaptations are incompletely understood. Recent epidemiologic studies have shown that mild (sodium, 130-135 mEq/L) and moderate (sodium, 121-129 mEq/L) chronic hyponatremia, long thought to be inconsequential, is associated with adverse outcomes. Adaptations of the heart, bone, brain, and (possibly) immune system to sustained mild to moderate hyponatremia may adversely affect their function and potentially the organism's survival. This review explores what is known about the consequences of mild to moderate chronic hyponatremia and the potential benefits of treating this condition.
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Affiliation(s)
| | - Richard H Sterns
- Rochester General Hospital, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY.
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18
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De Vecchis R, Ariano C, Di Biase G, Noutsias M. Thiazides and Osteoporotic Spinal Fractures: A Suspected Linkage Investigated by Means of a Two-Center, Case-Control Study. J Clin Med Res 2017; 9:943-949. [PMID: 29038673 PMCID: PMC5633096 DOI: 10.14740/jocmr3193w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 01/23/2023] Open
Abstract
Background An alleged association of chronic use of thiazide diuretics with an increased risk of bone fragility fractures has been highlighted by a relatively recent prospective cohort study. However, the concept that thiazides exert a beneficial effect on osteoporosis is still a predominant view. This effect would be mediated by the decrease in renal clearance of calcium ions, a pharmacological feature recognized for a long time now to this class of drugs, as opposed to the increase in calcium urinary excretion attributed instead to loop diuretics, i.e. furosemide and similar drugs. The purpose of this retrospective study was to attempt to clarify whether regular use of thiazide diuretics as antihypertensive therapeutics is associated with a significantly increased risk of osteoporotic fractures in female patients aged 65 or over. Methods In this two-center retrospective study, we followed up a cohort of female patients with (n = 80) and without (n = 158) thiazide-induced hyponatremia. Results A total of 48 osteoporotic fractures were recorded during a median follow-up period of 57.5 months. By means of univariate regression analysis, an association was found between thiazide-induced hyponatremia and increased risk of vertebral fractures (odds ratio (OR): 7.6; 95% confidence interval (CI): 3.755 - 15.39; P < 0.0001). Multivariate regression analysis, however, showed that age (OR: 1.823; 95% CI: 1.211 - 2.743) and body mass index (OR: 0.156; 95% CI: 0.038 - 0.645) were the only independent predictors of osteoporotic fractures. No association of a history of thiazide-induced hyponatremia and risk of fracture was noticeable in the final model. Conclusions Because thiazide-induced hyponatremia was associated with spinal fractures in univariate but not multivariate analysis, a possible explanation is that hyponatremia may be a confounder of the relation between body mass and spinal fractures. Indeed, reduced body mass especially among elderly women with small body build may confer heightened risk of thiazide-induced hyponatremia because of decreased bone sodium available for exchange with the serum sodium. Thus, occurrence of hyponatremia could only serve as an indirect surrogate marker for osteoporosis risk.
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Affiliation(s)
- Renato De Vecchis
- Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", via Cagnazzi 29, 80137 Napoli, Italy
| | - Carmelina Ariano
- Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", via Cagnazzi 29, 80137 Napoli, Italy.,Division of Cardiology, Casa di Cura "Sollievo della Sofferenza", viale Cappuccini 2, 71013 San Giovanni Rotondo, Italy
| | - Giuseppina Di Biase
- Division of Geriatrics, Neurorehabilitation Unit, Clinic "S. Maria del Pozzo", via Pomigliano 40, 80049 Somma Vesuviana, Italy
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, D-06120 Halle, Germany
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19
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Formiga F, Ruiz D. [Sodium; a geriatric parameter]. Rev Esp Geriatr Gerontol 2017; 52:59-60. [PMID: 28038781 DOI: 10.1016/j.regg.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Domingo Ruiz
- Unidad de Geriatría, Hospital de Sant Pau, Barcelona, España
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20
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Paik JM, Rosen HN, Gordon CM, Curhan GC. Diuretic Use and Risk of Vertebral Fracture in Women. Am J Med 2016; 129:1299-1306. [PMID: 27542612 PMCID: PMC5118092 DOI: 10.1016/j.amjmed.2016.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vertebral fracture is the most common type of osteoporotic fracture. While thiazide diuretics, which are commonly prescribed for the treatment of hypertension, decrease calciuria, they may also induce hyponatremia, which has been associated with increased vertebral fracture risk. Loop diuretics increase calciuria, which would reduce bone mineral density and increase vertebral fracture risk, but they rarely cause hyponatremia. Recent studies on diuretics and fractures did not include or specifically examine vertebral fracture. The few studies of diuretics and vertebral fracture have been limited by cases defined by self-report or administrative data, relatively small number of cases, study design that was not prospective, and lack of long-term follow-up with updated information on diuretic use. METHODS We conducted a prospective cohort study of thiazide diuretic use, loop diuretic use, and risk of incident clinical vertebral fracture in 55,780 women, 55-82 years of age, participating in the Nurses' Health Study, without a prior history of any fracture. Diuretic use was assessed by questionnaire every 4 years. Self-reported vertebral fracture was confirmed by medical record review. Cox proportional-hazards models were used to simultaneously adjust for potential confounders. RESULTS Our analysis included 420 incident vertebral fracture cases documented between 2002 and 2012. The multivariate-adjusted relative risk of clinical vertebral fracture for women taking thiazides compared with women not taking thiazides was 1.47 (95% confidence interval, 1.18-1.85). The multivariate adjusted relative risk of vertebral fracture for women taking loop diuretics compared with women not taking loop diuretics was 1.59 (95% confidence interval, 1.12-2.25). CONCLUSION Thiazide diuretics and loop diuretics are each independently associated with increased risk of vertebral fracture in women.
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Affiliation(s)
- Julie M. Paik
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Harold N. Rosen
- Endocrinology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Catherine M. Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Gary C. Curhan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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21
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Leth-Møller KB, Hansen AH, Torstensson M, Andersen SE, Ødum L, Gislasson G, Torp-Pedersen C, Holm EA. Antidepressants and the risk of hyponatremia: a Danish register-based population study. BMJ Open 2016; 6:e011200. [PMID: 27194321 PMCID: PMC4874104 DOI: 10.1136/bmjopen-2016-011200] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia. DESIGN Retrospective register-based cohort study using nationwide registers from 1998 to 2012. SETTING The North Denmark Region. PARTICIPANTS In total, 638 352 individuals were included. PRIMARY AND SECONDARY OUTCOME MEASURES Plasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models. RESULTS An event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14). CONCLUSIONS All antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.
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Affiliation(s)
| | | | - Maia Torstensson
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Lars Ødum
- Department of Biochemistry, University Hospital Zealand, Roskilde, Denmark
| | | | | | - Ellen Astrid Holm
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Rosner MH, Perazella MA, Choi MJ. American Society of Nephrology Quiz and Questionnaire 2015: Electrolytes and Acid-Base Disorders. Clin J Am Soc Nephrol 2016; 11:735-44. [PMID: 26825098 DOI: 10.2215/cjn.12801215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the annual Kidney Week meeting of the American Society of Nephrology. During the 2015 meeting the conference hall was once again overflowing with eager quiz participants. Topics covered by the experts included electrolyte and acid-base disorders, glomerular disease, end-stage renal disease and dialysis, and kidney transplantation. Complex cases representing each of these categories together with single-best-answer questions were prepared and submitted by the panel of experts. Before the meeting, training program directors of nephrology fellowship programs and nephrology fellows in the United States answered the questions through an internet-based questionnaire. During the live session members of the audience tested their knowledge and judgment on the same series of case-oriented questions in a quiz. The audience compared their answers in real time using a cell-phone app containing the answers of the nephrology fellows and training program directors. The results of the online questionnaire were displayed, and then the quiz answers were discussed. As always, the audience, lecturers, and moderators enjoyed this highly educational session. This article recapitulates the session and reproduces selected content of educational value for theClinical Journal of the American Society of Nephrologyreaders. Enjoy the clinical cases and expert discussions.
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Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia;
| | - Mark A Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; and
| | - Michael J Choi
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
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Hyponatremia in cancer patients: Time for a new approach. Crit Rev Oncol Hematol 2016; 102:15-25. [PMID: 27066939 DOI: 10.1016/j.critrevonc.2016.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 02/10/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022] Open
Abstract
Hyponatremia is a common electrolyte disorder in cancer patients. It may be related to cancer, to anti-cancer therapy or to other concomitant treatments. In this setting hyponatremia is often caused by the syndrome of inappropriate anti-diuretic hormone secretion, which is due to the ectopic production of antidiuretic hormone (vasopressin), to extracellular fluid depletion, to renal toxicity caused by chemotherapy or to other underlying conditions. Recent studies suggested that hyponatremia might be considered a negative prognostic factor for cancer patients therefore its early detection, monitoring and management might improve the patient's outcome. Treatment of hyponatremia depends on patient's symptoms severity, onset timing and extracellular volume status. In this review we summarize the main causes of hyponatremia in cancer patients and its management, including the available treatment options.
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Albright RC. Hyponatremia Management: Walking the Tightrope Without a Net. Mayo Clin Proc 2015; 90:1320-2. [PMID: 26434958 DOI: 10.1016/j.mayocp.2015.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Robert C Albright
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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Abstract
PURPOSE OF REVIEW Predicting fracture risk is a major challenge because it allows the prevention of major osteoporotic fracture in high-risk populations. With the aging of the population, this matter will become of even greater importance. In recent years, novel clinical, biochemical, and imaging tools have been developed to improve the assessment of fracture risk. RECENT FINDINGS The present review summarizes novel clinical strategies, Dual energy X-ray absorptiometry (DXA)-derived tools, imaging techniques, and biochemical markers that have been developed recently to improve fracture risk prediction. SUMMARY DXA and clinical fracture risk prediction tools are preferential markers of fracture risk. Clinical fracture risk alone might be used if DXA facilities are unavailable. The fracture risk assessment tool may be used in osteoporosis consultation in many countries. Other tools may be used soon after more studies are performed, particularly trabecular bone score, quantitative ultrasound, bone turnover markers. Specific factors for example falls, hip axis length, vertebral fracture assessment could be used in individual patients. This may significantly improve the clinical decision-making.
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Affiliation(s)
- Catherine Cormier
- aDepartment of Rheumatology A, Cochin Hospital bPhysiology Department, Necker-Enfants-Malades Hospital, Paris Descartes University, Paris, France
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Usala RL, Fernandez SJ, Mete M, Cowen L, Shara NM, Barsony J, Verbalis JG. Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in a Large US Health System Population. J Clin Endocrinol Metab 2015; 100:3021-31. [PMID: 26083821 PMCID: PMC4524991 DOI: 10.1210/jc.2015-1261] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT The significance of studies suggesting an increased risk of bone fragility fractures with hyponatremia through mechanisms of induced bone loss and increased falls has not been demonstrated in large patient populations with different types of hyponatremia. OBJECTIVE This matched case-control study evaluated the effect of hyponatremia on osteoporosis and fragility fractures in a patient population of more than 2.9 million. DESIGN, SETTING, AND PARTICIPANTS Osteoporosis (n = 30 517) and fragility fracture (n = 46 256) cases from the MedStar Health database were matched on age, sex, race, and patient record length with controls without osteoporosis (n = 30 517) and without fragility fractures (n = 46 256), respectively. Cases without matched controls or serum sodium (Na(+)) data or with Na(+) with a same-day blood glucose greater than 200 mg/dL were excluded. MAIN OUTCOME MEASURES Incidence of diagnosis of osteoporosis and fragility fractures of the upper or lower extremity, pelvis, and vertebrae were the outcome measures. RESULTS Multivariate conditional logistic regression models demonstrated that hyponatremia was associated with osteoporosis and/or fragility fractures, including chronic [osteoporosis: odds ratio (OR) 3.97, 95% confidence interval (CI) 3.59-4.39; fracture: OR 4.61, 95% CI 4.15-5.11], recent (osteoporosis: OR 3.06, 95% CI 2.81-3.33; fracture: OR 3.05, 95% CI 2.83-3.29), and combined chronic and recent hyponatremia (osteoporosis: OR 12.09, 95% CI 9.34-15.66; fracture: OR 11.21, 95% CI 8.81-14.26). Odds of osteoporosis or fragility fracture increased incrementally with categorical decrease in median serum Na(+). CONCLUSIONS These analyses support the hypothesis that hyponatremia is a risk factor for osteoporosis and fracture. Additional studies are required to evaluate whether correction of hyponatremia will improve patient outcomes.
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Affiliation(s)
- Rachel L Usala
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Stephen J Fernandez
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Mihriye Mete
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Laura Cowen
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Nawar M Shara
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Julianna Barsony
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Joseph G Verbalis
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
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Braconnier A, Vrigneaud L, Bertocchio JP. [Hyponatremias: From pathophysiology to treatments. Review for clinicians]. Nephrol Ther 2015; 11:201-12. [PMID: 26095871 DOI: 10.1016/j.nephro.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
Hyponatremia could be defined as a public health topic: too many patients are concerned in both hospitalized and general populations; hyponatremia induces lots of clinical outcomes and a great economic burden. Its pathophysiology involves thirst regulation (hypotonic water intakes) and losses regulation (through the kidney under vasopressin control). Diagnostic approach should insure that hyponatremia reflects hypo-osmolality and hypotonicity: first, a false hyponatremia should be ruled out, then a non-hypotonic one. Next step is clinic: extracellular status should be evaluated. When increased, any edematous status should be evoked: heart failure, liver cirrhosis or nephrotic syndrome. When decreased, any cause of extracellular dehydration should be evoked: natriuresis could help distinguishing between renal (adrenal insufficiency, diuretics use or salt-losing nephropathy) or extrarenal (digestive mostly) etiologies. When clinically normal, a secretion of inappropriate antidiuretic hormone (SIADH) should be evoked, once hypothyroidism or hypoadrenocorticism have been ruled out. Therapy depends on the severity of the clinical impact. From extracellular rehydration, through fluid restriction, the paraneoplastic and heart failure-induced SIADH benefit from a new class of drug, available among the therapeutic strategies: aquaretics act through antidiuretic hormone receptor antagonism (vaptans). Their long-term benefits still have to be proven but it is a significant step forward in the treatment of hyponatremias.
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Affiliation(s)
- Antoine Braconnier
- Service de néphrologie, hémodialyse, transplantation, hôpital Maison-Blanche, CHU de Reims, avenue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université Reims Champagne Ardenne, 51000 Reims, France; Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France
| | - Laurence Vrigneaud
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie, médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, CS 50479, 59322 Valenciennes cedex, France
| | - Jean-Philippe Bertocchio
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service d'explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex, France; Université Paris Descartes, 75006 Paris, France.
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