Evaluation of the maintenance therapy(s) in the syndrome of inappropriate anti-diuresis

FLUID, ELECTROLYTES, AND ACID-BASE BALANCE: Evaluation of the maintenance therapy(s) in the syndrome of inappropriate anti-diuresis (SIADH) (Sep. 2020

 

FLUID, ELECTROLYTES, AND ACID-BASE BALANCE: Evaluation of the maintenance therapy(s) in the syndrome of inappropriate anti-diuresis (SIADH) (Sep. 2020)

Ptns presented with chronic hyponatremia owing to the syndrome of inappropriate anti-diuresis (SIADH) usually require maintenance therapy with fluid restriction and oral Na chloride, with or without loop diuretic. In a RCT (randomized controlled trial) of 92 ptns with SIADH and serum Na <130 mEq/L, the adminstrtion of oral Na chloride or oral Na chloride + furosemide to fluid restriction would not significantly results in a rise of the serum Na, as compared with fluid restriction alone. However, the dose of oral Na chloride administered in the trial (3 g/d) was substantially lower than what is usually recommended, and the furosemide was dosed once per day in the trial (twice daily dose is better recommended to impede the unopposed anti-diuresis once the effect of furosemide declined). Thus, it is continued to recommend a high-dose oral Ne chloride and, if needed, twice daily furosemide in addition to fluid restriction in ptns who require maintenance therapy for SIADH.  

Krisanapan P, Vongsanim S, Pin-On P, et al. Efficacy of Furosemide, Oral Sodium Chloride, and Fluid Restriction for Treatment of Syndrome of Inappropriate Antidiuresis (SIAD): An Open-label Randomized Controlled Study (The EFFUSE-FLUID Trial). Am J Kidney Dis 2020; 76: 203.

 

GLOMERULAR DISEASE & VASCULITIS: Targeting CD38 in patients with refractory systemic lupus erythematosus (October 2020)

The long-lived, AB-secreting plasma cells have been involved in the evolution and pathogenetic development of SLE (systemic lupus erythematosus) but usually NOT responsive to the standard im/m. therapies. Therapeutic administration of daratumumab, a CD38-directed monoclonal AB capable of depleting plasma cells, was described in 2 ptns presented with life-threatening, ttt-refractory complications of SLE (namely lupus nephritis, pericarditis, and autoimmune hemolytic anemia). In both cases, daratumumab (Darzalex) produced favorable clinical and serologic response without any rise in the risk of serious infectious events. While promising, these findings require confirmation in larger clinical trials to determine whether daratumumab will eventually play a role in the ttt of ptns with SLE, particularly those with serious complications.  

Ostendorf L, Burns M, Durek P, et al. Targeting CD38 with Daratumumab in Refractory Systemic Lupus Erythematosus. N Engl J Med 2020; 383:1149.