Journal of Clinical & Experimental Nephrology

New evidence for high prevalence of renal salt wasting (RSW), identification of novel protein in RSW to simplify diagnosis of RSW and introducing new syndrome of RSW in Alzheimer’s disease

14^th World Nephrology Conference
June 27-28, 2024 | Paris, France

John K. Maesaka

NYU Langone Health, USA

ScientificTracks Abstracts: J Clin Exp Nephrol

Abstract

Backround: Cerebral/renal salt wasting (RSW) is considered rare and presents with identical parameters as SIADH that creates a diagnostic and therapeutic dilemma, to fluid-restrict water logged patients with SIADH or administer saline to dehydrated patients with RSW. We previously demonstrated the presence of a natriuretic protein (NP) in the plasma of RSW neurosurgical patients and in patients with Alzheimer’s disease (AD). Methods: We utilized a new algorithm to determine the different causes of hyponatremia and identified the NP in an RSW patient with subarachnoid hemorrhage (SAH) and another with AD by the same rat clearance methodology. Results: Of 62 hyponatremic patients, (A) 17 patients (27%) had SIADH, (B) 19 patients (31%) had a reset osmostat (RO), (C) 24 patients (38%) had RSW, 21without clinical evidence of cerebral disease (D) 1 patient had Addison disease and (E) 1 patient (1.6%) due to hydrochlorothiazide. The normonatremic SAH and AD sera had identical robust dose-dependent increases in FE (fractional excretion) sodium and FElithium, lithium serving as a marker of proximal tubule sodium transport. The NP in the SAH and AD sera was identified as haptoglobin related protein without signal peptide (HPRWSP). Conclusions: RSW is common. HPRWSP may be the NF in RSW, can serve as a biomarker to differentiate RSW from SIADH on first encounter and introduces a new syndrome of RSW in AD that occurs early in AD and becomes more dehydrated as the dementia worsens. RSW is common in normonatremic patients.

Biography

John Maesaka, professor of medicine at NYU Grossman Long Island School of Medicine and Chief Emeritus, Division of Nephrology and Hypertension at the NYU Langone Hospital Long Island. He received a BA degree friom Harvard University, MD degree from Boston University School of Medicine and trained at Barnes Jewish Hospital Washington University in St. Louis and Mount Sinai Hospital and Medical School N.Y. He spent 5 years in a physiology laboratory at Mount Sinai Medical Center, which prepared him for his future research endeavors. He spent many years study ing hyponatremic conditions, especially renal salt wasting and identifying the protein that causes it.