Skip to main content

N-terminal B-type natriuretic peptide and renal function parameters in cerebral salt wasting syndrome

Introduction

Elevated levels of B-type natriuretic peptides are reported in hypo-osmolal hyponatraemia with natriuresis in cerebral salt wasting (CSW) syndrome. The aim of our study was to evaluate serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and its relationship with renal function parameters in patients with acute brain diseases who developed CSW.

Methods

We prospectively measured NT-proBNP in 12 patients (mean age 46 ± 17 years, seven men) with acute brain diseases (four subarachnoid haemorrhage, five tumour, three trauma, mean Glasgow Coma Scale 13 ± 2.7). All patients were classified as New York Heart Association (NYHA) I and none had pulmonary oedema. The mean Glasgow Outcome Scale upon discharge from the neurologic–neurosurgical ICU was 4 ± 1.2. Diagnoses of CSW (mean serum sodium 129 ± 3.6 mmol/l) were stated by evaluation of renal function parameters – only with clearance of creatinine above 1.15 ml/s. Urine was collected within 24 hours. The control group was made up of patients with acute brain diseases, normonatraemia, NYHA I and normal renal parameters (n = 20 patients).

Results

We found significantly higher levels of NT-proBNP in patients with CSW (430.4 ± 706.4 pg/ml) compared not only with the reference range (125 pg/ml, P = 0.001) but also with the control group (268.3 ± 203.9, P < 0.001). There were no differences in fluid intake (P = 0.440) between the two groups, but patients with CSW had higher sodium intake per kilogram of body weight (P = 0.024), diuresis (P = 0.019), daily sodium output (P = 0.036), electrolyte clearance (P = 0.001) and sodium clearance (P = 0.007). Further analysis of the control group did not show any relationship between NT-proBNP and measured parameters, in contrast to CSW, where we found a negative relation between NT-proBNP and serum sodium (P = 0.022), fluid intake (P = 0.047), osmotically active substances clearance (P = 0.031) and electrolyte clearance (P = 0.047). No further correlations were found.

Conclusion

Our results showed that natriuresis with hypo-osmolal hyponatraemia in CSW were related to significant higher serum levels of NT-proBNP with a negative correlation to serum sodium and fluid intake, compared with patients with acute brain disease and normonatraemia.

References

  1. 1.

    Berendes E, et al.: Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage. Lancet 1997, 349: 245-249. 10.1016/S0140-6736(96)08093-2

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Spatenkova, V., Kazda, A., Skrabalek, P. et al. N-terminal B-type natriuretic peptide and renal function parameters in cerebral salt wasting syndrome. Crit Care 12, P446 (2008). https://doi.org/10.1186/cc6667

Download citation

Keywords

  • Natriuretic Peptide
  • Glasgow Coma Scale
  • Serum Sodium
  • Fluid Intake
  • Sodium Intake