title: [Hyponatremias: From pathophysiology to treatments. Review for clinicians].
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.
authors.affiliation: 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.
authors.forename: Antoine
authors.initials: A
authors.lastname: Braconnier
authors.affiliation: 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.
authors.forename: Laurence
authors.initials: L
authors.lastname: Vrigneaud
authors.affiliation: 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. Electronic address: jean-philippe.bertocchio@egp.aphp.fr.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bertocchio
mesh_terms: D001127:Arginine Vasopressin / Q000502:physiology; D003663:Decision Trees; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000503:physiopathology
chemical_list: D001127:Arginine Vasopressin
keywords: Hyponatremia; Hyponatrémie; Inappropriate ADH syndrome; Physiopathologie; Physiopathology; Receptors; Récepteurs à la vasopressine; Syndrome de sécrétion inappropriée d’ADH; Vasopressin