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Figure 1 | BMC Nephrology

Figure 1

From: Hyponatremia in a patient with scleroderma renal crisis: a potential role of activated renin-angiotensin system

Figure 1

Clinical course. The patient was initially treated with enalapril maleate (Enalapril) for SRC. On the 8th day of hospitalization, the patient’s consciousness deteriorated and the serum sodium level was dropped to 116 mEq/L. The level of antidiuretic hormone (ADH) was inappropriately high for the serum osmolarity. The plasma renin activity and angiotensin I level were also extremely high on the same day (see Table 1). After the switch from Enalapril to candesartan cilexetil (Candesartan) due to skin eruptions, hyponatremia similarly developed on 40th and 60th days of hospitalization, respectively. Laboratory data also revealed improperly high levels of ADH, extremely high plasma renin activities and high angiotensin levels. However, hyponatremia had not occurred after the increased dose of Candesartan and the addition of aliskiren fumarate (Aliskiren). The plasma renin activity and angiotensin levels were normalized (see Table 1) and the renal function was preserved. Conversion factors for units: serum creatinine in mg/dl to μmol/L, x 88.4. No conversion is necessary for serum sodium in mEq/L and mmol/L.

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