Cover Kidney News
Volume/Issue:
Volume 13: Issue 3
Page:
13–14
Publication Date:
01 Mar 2021
Online Publication Date:
05 Mar 2021
  • 1.

    Verbalis JG, et al.. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med 2013; 126 (10 Suppl 1):S1−S42. doi: 10.1016/j.amjmed.2013.07.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Rondon-Berrios H. Urea for chronic hyponatremia. Blood Purif 2020; 49:212−218. doi: 10.1159/000503773

  • 3.

    Sterns RH, et al.. Urea for hyponatremia? Kidney Int 2015; 87:268−270. doi: 10.1038/ki.2014.320

  • 4.

    Crawford H, McIntosh JF. The use of urea as a diuretic in heart failure. Arch Intern Med (Chic) 1925; 36:530−541. doi:10.1001/archinte.1925.00120160088004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Decaux G, et al.. Hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone. Rapid correction with urea, sodium chloride, and water restriction therapy. JAMA 1982; 247:471−474. doi: 10.1001/jama.1982.03320290017021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Spasovski G, et al.. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med 2014; 40:320−331. doi: 10.1007/s00134-014-3210-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Rondon-Berrios H, et al.. Urea for the treatment of hyponatremia. Clin J Am Soc Nephrol 2018; 13:1627−1632. doi: 10.2215/CJN.04020318

  • 8.

    Decaux G, et al.. Treatment of euvolemic hyponatremia in the intensive care unit by urea. Crit Care 2010; 14:R184. doi: 10.1186/cc9292

  • 9.

    Nervo A, et al.. Urea in cancer patients with chronic SIAD-induced hyponatremia: Old drug, new evidence. Clin Endocrinol (Oxf) 2019; 90:842−848. doi: 10.1111/cen.13966

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Soupart A, et al.. Efficacy and tolerance of urea compared with vaptans for long-term treatment of patients with SIADH. Clin J Am Soc Nephrol 2012; 7:742−747. doi: 10.2215/CJN.06990711

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Lockett J, et al.. Urea treatment in fluid restriction refractory hyponatremia. Clin Endocrinol (Oxf) 2019; 90:630−636. doi: 10.1111/cen.13930

  • 12.

    Soupart A, et al.. Azotemia (48 h) decreases the risk of brain damage in rats after correction of chronic hyponatremia. Brain Res 2000; 852:167−172. doi: 10.1016/s0006-8993(99)02259-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Pierrakos C, et al.. Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: A single-center experience. Ann Intensive Care 2012; 2:13. doi: 10.1186/2110-5820-2-13

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Gankam Kengne F, et al.. Urea minimizes brain complications following rapid correction of hyponatremia compared with vasopressin antagonist or hypertonic saline. Kidney Int 2015; 87:323−331. doi: 10.1038/ki.2014.273

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Rondon-Berrios H. Urea for chronic hyponatremia. ClinicalTrials.gov: NCT04588207. https://clinicaltrials.gov/ct2/show/NCT04588207?cond=urea+hyponatremia&draw=2&rank=1

    • Search Google Scholar
    • Export Citation
Editorial Type:
Special Section

Urea for the Treatment of Hyponatremia: An Old Treatment Offers Fresh Hope

Edgar V. Lerma1 and Helbert Rondon-Berrios1
  • 1 Edgar Lerma, MD, is Clinical Professor of Medicine and Educational Coordinator for the Section of Nephrology at the University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, IL. Helbert Rondon-Berrios, MD, is Associate Professor of Medicine and Program Director of the Nephrology Fellowship Program in the Renal-Electrolyte Division at the University of Pittsburgh School of Medicine, PA.
Volume/Issue:
Volume 13: Issue 3
Publication Date:
01 Mar 2021
Page:
13–14
Restricted access

The conventional first-line therapy for any patient presenting with hypotonic hyponatremia due to SIAD (syndrome of inappropriate antidiuresis) is that of fluid restriction. However, we recognize that fluid restriction alone does not always work. The Expert Panel Recommendations on Diagnosis, Evaluation, and Treatment of Hyponatremia, published in 2013, identified certain criteria that are predictive of which patients are less likely to respond to fluid restriction alone (1). These include a urine-to-plasma electrolyte ratio ([urine Na + urine K]/plasma sodium [PNa]) >1 or a high urine osmolality (>500 mOsm/kg H2O).

It has been suggested that those patients
Save