Abstract: PUB130
Too Much Fluid, Too Little Solute: A Case of Life-Threatening Hyponatremia in an Adult with Minimal Change Disease
Session Information
Category: Glomerular Diseases
- 1401 Glomerular Diseases: Mechanisms, including Podocyte Biology
Authors
- Mirza, Sabbir, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Rodriguez, Cindy, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Kanu, Donald Orji, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Isidor, Marc H., HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Khan, Rahil, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Razuman, Samerah Guro, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
Group or Team Name
- Team Lawnwood
Introduction
Minimal change disease (MCD) in adults is associated with relapsing nephrotic syndrome and fluid imbalance; however, severe hyponatremia is an uncommon and underrecognized complication. It reflects impaired free water clearance driven by reduced effective arterial volume and non-osmotic antidiuretic hormone (ADH) release.
Case Description
A 62-year-old woman with biopsy-proven adult MCD, CKD3b, and HTN presented with 2 weeks of weakness, anorexia, abdominal distention, and leg edema while on prednisone 40 mg/day for the last 2 years. MCD was diagnosed in 2024; nephrology documented initial steroid response, relapse last year, and repeat biopsy showing MCD still present. Admission Na 109 mmol/L, serum osmol. 255 mOsm/kg, albumin 2.1 g/dL, creatinine 1.80 mg/dL, eGFR 32. Urine PCR/24-hour protein unspecified; dip protein 600 mg/dL. Volume notes were mixed (euvolemic vs hypervolemic), but exam showed anasarca/edema. UNa <20 and Uosm 258; ADH assessment unspecified. TSH normal; AM cortisol 6.28, significance unspecified. Early balance +633 mL; loop diuretics not documented. Severe hyponatremia preceded MMF/salt/urea. She received NS, 3% saline, albumin, fluid restriction, then salt tabs/urea and MMF; Na improved to 123 and Cr to 1.5 with ICU downgrade.
Discussion
Hyponatremia in nephrotic syndrome results from decreased effective arterial blood volume despite total body fluid overload, leading to non-osmotic ADH secretion and impaired free water excretion. Contributing factors in this case likely included low solute intake and reduced glomerular filtration. Careful correction is essential to avoid osmotic demyelination.
This case is notable for the severity of hyponatremia (Na 109 mmol/L) in adult MCD, which is rarely reported, and for demonstrating how concurrent steroid-resistant nephrotic relapse, hypoalbuminemia, and low solute intake can synergistically impair free water clearance. Recognition of this mechanism is critical, as management requires not only controlled sodium correction but also targeted treatment of the underlying nephrotic state.
Acknowledgment
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Sodium Correction
| Date | Sodium (mmol/L) | Clinical Context |
| 4/29/26 | 109 | Admission (ICU) |
| 4/30/26 | 111-114 | Initial Correction Phase - Slow Hypertonic Saline |
| 5/1/26 | 116-120 | Increase rate of Hypertonic Saline |
| 5/2/26 | 120-121 | Transition off Hypertonic Saline |
| 5/3/26 | 122-123 | Stable Correction |