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2018 ; 20
(4
): 31
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Clinical and Molecular Features of Thiazide-Induced Hyponatremia
#MMPMID29637415
Nadal J
; Channavajjhala SK
; Jia W
; Clayton J
; Hall IP
; Glover M
Curr Hypertens Rep
2018[Apr]; 20
(4
): 31
PMID29637415
show ga
PURPOSE OF REVIEW: Hypertension affects more than 30% of the world's adult
population and thiazide (and thiazide-like) diuretics are amongst the most widely
used, effective, and least costly treatments available, with all-cause mortality
benefits equivalent to angiotensin-converting enzyme inhibitors or calcium
channel antagonists. A minority of patients develop thiazide-induced hyponatremia
(TIH) and this is largely unpredictable at the point of thiazide prescription. In
some cases, TIH can cause debilitating symptoms and require hospital admission.
Although TIH affects only a minority of patients exposed to thiazides, the high
prevalence of hypertension leads to TIH being the most common cause of
drug-induced hyponatremia requiring hospital admission in the UK. This review
examines current clinical and scientific understanding of TIH. Consideration is
given to demographic associations, limitations of current electrolyte monitoring
regimens, clinical presentation, the phenotype evident on routine clinical blood
and urine tests as well as more extensive analyses of blood and urine in research
settings, recent genetic associations with TIH, and thoughts on management of the
condition. RECENT FINDINGS: Recent genetic and phenotyping analysis has suggested
that prostaglandin E2 pathways in the collecting duct may have a role in the
development of TIH in a subgroup of patients. Greater understanding of the
molecular pathophysiology of TIH raises the prospect of pre-prescription TIH risk
profiling and may offer novel insights into how TIH may be avoided, prevented and
treated. The rising prevalence of hypertension and the widespread use of
thiazides mean that further understanding of TIH will continue to be a pressing
issue for patients, physicians, and scientists alike for the foreseeable future.
|Diuretics/*adverse effects/therapeutic use
[MESH]