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Abstract
Recent data have shown the role of urea in the urinary concentrating mechanism. We
studied the effects of exogenous urea administration in hyponatremia associated with
the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In 20 patients
with SIADH, we observed a positive correlation between serum sodium and blood urea
levels (r = 0.65; p < 0.01). In one patient with an oat cell carcinoma and SIADH-induced
hyponatremia, we observed the same positive correlation (r = 0.80; p < 0.01) but also
a negative one between the excreted fraction of filtered sodium and urinary urea (r
= -0.67; p < 0.001). The short-term administration of low doses of urea (4 to 10 g)
resulted in correcting the “salt-losing” tendency of this patient. Longer term administration
of high doses of urea (30 g/day) was attempted with the same patient as well as with
a healthy volunteer subject with Pitressin®-induced SIADH. In both patients, urea treatment lowered urinary sodium excretion
as long as hyponatremia was significant (< 130 meq/liter). Urea treatment also induced
a persistent osmotic diuresis, allowing a normal daily intake of water despite SIADH.
This was clearly shown during the long-term treatment of a third patient with SIADH
who was taking 30 g urea/day during 11 weeks.
It is concluded that urea is a good alternative in the treatment of patients with
SIADH who present with persistent hyponatremia despite the restriction of water intake.
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Article info
Publication history
Accepted:
January 11,
1980
Footnotes
☆This study was supported by a grant from the Ministére de la Politique Scientifique (Actions concertées).
Identification
Copyright
© 1980 Published by Elsevier Inc.
