Abstract
We report a case of nephrogenic syndrome of inappropriate antidiuresis caused by carbamazepine (CBZ). CBZ, an antiepileptic drug, is known to cause hyponatremia. The mechanism is generally considered to be inappropriate secretion of antidiuretic hormone, whereas an experimental study suggests a direct effect of CBZ on the kidney by stimulating vasopressin receptor. An 18-year-old male with atypical autism and epilepsy has been treated with CBZ and clobazam since age 9 and 10 years, respectively. At age 11, he was found to have asymptomatic hyponatremia. He had the habit of drinking tea approximately 3 L/day. The low plasma osmolality and high urine osmolality and sodium concentration in the presence of normal thyroid and adrenal function were compatible with syndrome of inappropriate excretion of antidiuretic hormone. His plasma vasopressin level, however, was undetectable. Urine cyclic AMP level was higher than expected from urine osmolality despite the suppressed plasma arginine vasopressin. With fluid restriction, hyponatremia improved. CBZ tapering begun later in the course maintained normal serum sodium concentrations with less strict water intake. This case demonstrates the direct effect of CBZ stimulating vasopressin receptor in the kidney leading to nephrogenic syndrome of inappropriate diuresis.
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References
Barash I, Ponda MP, Goldfarb DS, Skolnik EY. A pilot clinical study to evaluate changes in urine osmolality and urine cAMP in response to acute and chronic water loading in autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol. 2010;5:693–7.
Van Amelsvoort T, Bakshi R, Devaux CB, Schwabe S. Hyponatremia associated with carbamazepine and oxcarbazepine therapy: a review. Epilepisia. 1994;35:181–8.
Stephens WP, Coe JY, Baylis PH. Plasma arginine vasopressin concentrations and antidiuretic action of carbamazepine. Br Med J. 1978;1:1445–7.
Meinders AE, Cejka V, Robertson GL. The antidiuretic action of carbamazepine in man. Clin Sci Mol Med. 1974;4:289–99.
Wales JK. Treatment of diabetes insipidus with carbamazepine. Lancet. 1975;306:948–51.
Tormey WP. Mechanisms of carbamazepine-induced antidiuresis. J Neuro Neurosurg Psychiatry. 1993;56:567.
Feldman BJ, Rosenthal SM, Vargas GA, Fenwick RG, Huang EA, Matsuda-Abedini M, Lustig RH, Mathias RS, Portale AA, Miller WL, Gitelman SE. Nephrogenic syndrome of inappropriate antidiuresis. New Engl J Med. 2005;352:1884–90.
Vandergheynst F, Brachet C, Heinrichs C, Decaux G. Long-term treatment of hyponatremic patients with nephrogenic syndrome of inappropriate antidiuresis: personal experience and review of published case reports. Nephron Clin Pract. 2012;120:c168–172.
de Bragança AC, Moyses ZP, Magaldi AJ. Carbamazepine can induce kidney water absorption by increasing aquaporin 2 expression. Nephrol Dial Transpl. 2010;25:3840–5.
Kalff R, Houtkooper MA, Meyer JW, Goedhart DM, Augusteijn R, Meinardi H. Carbamazepine and serum sodium levels. Epilepsia. 1984;25:390–7.
Henry DA, Lawson DH, Reavey P, Renfrew S. Hyponatraemia during carbamazepine treatment. Br Med J. 1977;1:83–4.
Ranta A, Wooten GF. Hyponatremia due to an additive effect of carbamazepine and thiazide diuretics. Epilepsia. 2004;45:879.
Matsumura M, Yamaguchi M, Sato T. Severe hyponatremia in a patient treated with levomepromazine and carbamazepine. Intern Med. 2001;40:459.
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Sekiya, N., Awazu, M. A case of nephrogenic syndrome of inappropriate antidiuresis caused by carbamazepine. CEN Case Rep 7, 66–68 (2018). https://doi.org/10.1007/s13730-017-0295-9
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DOI: https://doi.org/10.1007/s13730-017-0295-9