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      Abnormal Antidiuretic Hormone Secretion in Patients with Systemic Lupus erythematosus

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          Abstract

          There have been anecdotal reports describing patients with systemic lupus erythematosus (SLE) and inappropriately elevated secretion of antidiuretic hormone (ADH), but no systematic studies of ADH and its metabolism in SLE have been performed. We measured plasma ADH levels in 36 stable SLE patients with normal renal function and examined the relationship of the circulating ADH concentration to clinical disease activity and effective extracellular fluid volume as reflected by peripheral plasma renin activity (PRA) and plasma aldosterone concentration. The mean ADH level was elevated, 11.4 ± 1.0 μU/ml (normal 0.4–1.4 μU/ml), while mean PRA and aldosterone were 5.4 ± 0.6 ng/ml/h and 10.6 ± 1.6 ng/l00 ml, respectively. When patients were divided into two groups according to disease duration, those with SLE for 2 years or more had significantly higher plasma ADH levels (13.9 ± 1.4 vs. 7.7 ± 0.9 μU/ml; p < 0.001 and urinary osmolality (697 ± 63 vs. 445 ± 49 mosm/kg; p < 0.02) compared to those with SLE of less than 2 years duration. No differences in serum Na + , K+, PRA, plasma aldosterone concentration, C3, or 24-hour urinary protein excretion were noted between these two groups. Six patients with SLE for less than 2 years underwent a standard water load (20 ml/kg); in 3/6 there was a paradoxical increase in the plasma ADH concentration. These findings indicate that SLE is associated with elevated plasma ADH levels that increase with prolonged disease duration. This abnormality is unrelated to the usual serologic indices of SLE activity, effective extracellular fluid volume status, or any apparent renal unresponsiveness to ADH. We therefore suggest that in patients with SLE, there exists a state of primary neurohypophyseal hypersecretion of ADH. This hypothesis is supported by the abnormal ADH secretory response in 3/6 patients who were given a free water load.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1987
          1987
          05 December 2008
          : 46
          : 1
          : 67-72
          Affiliations
          Departments of Pediatrics (Renal Division) and Medicine (Rheumatology Division), State University of New York-Downstate Medical Center, Brooklyn, N.Y., USA
          Article
          184305 Nephron 1987;46:67–72
          10.1159/000184305
          3600913
          © 1987 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 6
          Categories
          Original Paper

          Cardiovascular Medicine, Nephrology

          Antidiuretic hormone, Systemic lupus erythematosus

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