natriuretic-peptide--brain and Hypernatremia

Topics: Aged; Anticholesteremic Agents; Aortic Valve Stenosis; Cause of Death; Ezetimibe, Simvastatin Drug Combination; Female; Humans; Hypernatremia; Hyponatremia; Incidence; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Peptide Fragments; Proportional Hazards Models

Craniopharyngioma, due to its sellar location, can be perioperatively complicated by different types of dysnatremia. We present a rare postoperative onset of a combination of three different mechanisms of dysnatremia with N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and renal function parameters in a boy with a good outcome after craniopharyngioma surgery: 1/ Central diabetes insipidus (CDI) onset immediately after the operation, hypernatremia with peak serum sodium (SNa) 158 mmol/l) caused by free water polyuria (electrolyte-free water clearance, EWC 0.104 ml/s), NT-proBNP 350 pg/ml; 2/ cerebral salt wasting (CSW) onset on day 7, hyponatremia (SNa 128 mmol/l) with hypoosmolality (measured serum osmolality, SOsm 265 mmol/kg) caused by natriuresis (sodium - daily output 605 mmol/day, fractional excretion 0.035), NT-proBNP 191 pg/ml; 3/ Polydypsia onset on day 11 caused hyponatremia (SNa 132 mmol/l), EWC 0.015, NT-proBNP 68 pg/ml.

Topics: Child; Craniopharyngioma; Humans; Hypernatremia; Male; Natriuretic Peptide, Brain; Neurosurgical Procedures; Peptide Fragments; Pituitary Neoplasms; Postoperative Complications

Although tolvaptan is a recently approved drug for heart failure and causes aquaresis without affecting renal function, its clinical efficacy for patients with acute decompensated heart failure (ADHF) is yet to be elucidated.. We conducted a prospective observational study in patients with ADHF and high risk for worsening renal function (WRF). Risk stratification for WRF was done by scoring system. Of 174 patients, 114 patients were included as high-risk population for WRF. Incidence of WRF, urine output within 24h and 48 h, and changes in brain natriuretic peptide (BNP) were recorded in 44 patients treated with tolvaptan plus conventional therapy, and 70 patients with only conventional therapy. Urine output at 24h and 48 h after admission were both significantly higher in the tolvaptan group (p=0.001 and <0.001, respectively), and changes in BNP were not significantly different (p=0.351). However, the incidence of WRF was significantly lower in the tolvaptan group compared to the conventional group (22.7% vs 41.4%, p=0.045). Logistic regression analysis showed that treatment with tolvaptan was an independent factor for reducing WRF (hazard ratio 0.28, 95% confidence interval; 0.10-0.84; p=0.023).. In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.

Topics: Acute Disease; Aged; Aged, 80 and over; Benzazepines; Comparative Effectiveness Research; Creatinine; Diuresis; Diuretics; Female; Furosemide; Heart Failure; Humans; Hypernatremia; Kidney Function Tests; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Prospective Studies; Renal Insufficiency; Time Factors; Tolvaptan; Urination