RENAL DISEASE WITH THE SALT LOSING SYNDROME: A REPORT OF FOUR CASES OF SO-CALLED "SALT LOSING NEPHRITIS"

Abstract

Four cases of renal disease exhibiting the features of salt depletion and corresponding to the cases formerly reported as salt-losing nephritis are presented. It is the authors'' purpose to point out the need for early recognition of salt depletion in chronic renal disease, to emphasize that not all patients with so-called "salt losing nephritis" present the advanced picture of Addison''s disease, to alert others to this complication in these days of salt restriction and the use of measures which eliminate the minerals from the body, and to stimulate further investigation of the nature of the pathologic-physiologic process of the tubular system during disease. In spite of the different kinds of renal disease reported as causing the salt-losing syndrome, one feature is common to all[long dash]dis-turbance of the tubular system. Although there does not appear to be a specific histologic change, there is a common physiologic difficulty: the failure to conserve Na and chloride in a normal way. As this phenomenon has been associated in some cases with Addison''s disease, the differentiation in some cases has been a diagnostic problem. Patients with the syndrome show clinical evidences of salt depletion in the blood but clinically may not have developed collapse, hypotension, muttering delirium, mental confusion, weakness and painful extremities. The syndrome should be suspected in all chronic renal insufficiency cases having impending uremia, as treatment may lead to gratifying therapeutic response and years of comfort to the patient.