Laboratory Studies

There are three essential laboratory tests in the evaluation of patients with hyponatremia that, together with the history and the physical examination, help to establish the primary underlying etiologic mechanism. In general, the etiology of the hyponatremia directs its management.^{[43, 44]}

These tests are as follows

Serum osmolality
Urine osmolality
Urinary sodium concentration

Serum osmolality readily differentiates between true hyponatremia and pseudo-hyponatremia secondary to hyperlipidemia, hyperproteinemia, or hypertonic hyponatremia. Sources of hypertonic hyponatremia include elevations of the following: Glucose, Mannitol, Glycine (after urologic or gynecologic procedures)^[45], Sucrose, Maltose (contained in IgG formulations)

Urine osmolality helps to differentiate between conditions associated with impaired free water excretion and primary polydipsia (or malnutrition), in which water excretion should be normal (provided intact kidney function). With primary polydipsia, as with malnutrition (severe decreased solute intake) and a reset osmostat, the urine osmolality is maximally dilute, generally less than 100 mOsm/kg. A urine osmolality greater than 100 mOsm/kg indicates impaired ability of the kidneys to dilute the urine. This usually is secondary to elevated vasopressin (antidiuretic hormone; ADH) levels, which can be physiologic or non-physiologic.

Urinary sodium concentration helps to differentiate between hyponatremia secondary to hypovolemia and the SIADH. With SIADH (and salt-wasting syndrome), the urine sodium is greater than 20-40 mEq/L. With hypovolemia, the urine sodium typically measures less than 20 mEq/L. However, if sodium intake in a patient with SIADH (or salt-wasting) happens to be low, then urine sodium may be low as well.

Ancillary tests

Serum uric acid levels can be important supportive information (they are typically reduced in SIADH and in salt wasting). After correction of hyponatremia, the hypouricemia corrects in SIADH but remains with a salt-wasting process.

Thyroid-stimulating hormone (TSH) and serum cortisol levels should be measured if hypothyroidism or hypoadrenalism is suspected.

Serum albumin, triglycerides, and serum protein electrophoresis are indicated for patients with iso-osmolar hyponatremia.

Imaging Studies

Head computed tomography (CT) scanning and chest radiography can be used to assess for an underlying etiology in select patients with suspected SIADH or cerebral salt wasting.

A diffusion weighted magnetic resonance imaging (MRI) can help evaluate patients suspected of ODS but, if MRI is unavailable, CT of the brain can be done.

Treatment & Management

Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol. 2017 May. 28 (5):1340-1349. [QxMD MEDLINE Link]. [Full Text].
Castillo JJ, Glezerman IG, Boklage SH, Chiodo J 3rd, Tidwell BA, Lamerato LE, et al. The occurrence of hyponatremia and its importance as a prognostic factor in a cross-section of cancer patients. BMC Cancer. 2016 Jul 29. 16:564. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct. 126 (10 Suppl 1):S1-42. [QxMD MEDLINE Link].
Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr. 2009 Jul. 46(7):577-83. [QxMD MEDLINE Link].
Silver SM, Schroeder BM, Bernstein P, Sterns RH. Brain adaptation to acute hyponatremia in young rats. Am J Physiol. 1999 Jun. 276 (6 Pt 2):R1595-9. [QxMD MEDLINE Link].
Gross P, Reimann D, Henschkowski J, Damian M. Treatment of severe hyponatremia: conventional and novel aspects. J Am Soc Nephrol. 2001 Feb. 12 Suppl 17:S10-4. [QxMD MEDLINE Link]. [Full Text].
Update: Exertional hyponatremia, active component, U.S. Armed Forces, 2003-2018. MSMR. 2019 Apr. 26 (4):27-31. [QxMD MEDLINE Link].
Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD. Mortality and serum sodium: do patients die from or with hyponatremia?. Clin J Am Soc Nephrol. 2011 May. 6 (5):960-5. [QxMD MEDLINE Link].
Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, et al. Prognostic importance of hyponatremia in acute ST-elevation myocardial infarction. Am J Med. 2004 Aug 15. 117 (4):242-8. [QxMD MEDLINE Link].
Bae MH, Kim JH, Jang SY, Park SH, Lee JH, Yang DH, et al. Hyponatremia at discharge as a predictor of 12-month clinical outcomes in hospital survivors after acute myocardial infarction. Heart Vessels. 2017 Feb. 32 (2):126-133. [QxMD MEDLINE Link].
Heuman DM, Abou-Assi SG, Habib A, Williams LM, Stravitz RT, Sanyal AJ, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004 Oct. 40 (4):802-10. [QxMD MEDLINE Link].
Kim MY, Baik SK, Yea CJ, Lee IY, Kim HJ, Park KW, et al. Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis. Eur J Gastroenterol Hepatol. 2009 Nov. 21 (11):1241-6. [QxMD MEDLINE Link].
Ginés P, Berl T, Bernardi M, Bichet DG, Hamon G, Jiménez W, et al. Hyponatremia in cirrhosis: from pathogenesis to treatment. Hepatology. 1998 Sep. 28 (3):851-64. [QxMD MEDLINE Link].
Huang H, Jolly SE, Airy M, Arrigain S, Schold JD, Nally JV, et al. Associations of dysnatremias with mortality in chronic kidney disease. Nephrol Dial Transplant. 2017 Jul 1. 32 (7):1204-1210. [QxMD MEDLINE Link]. [Full Text].
Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999 Aug 19. 341 (8):577-85. [QxMD MEDLINE Link]. [Full Text].
Bettari L, Fiuzat M, Shaw LK, Wojdyla DM, Metra M, Felker GM, et al. Hyponatremia and long-term outcomes in chronic heart failure--an observational study from the Duke Databank for Cardiovascular Diseases. J Card Fail. 2012 Jan. 18 (1):74-81. [QxMD MEDLINE Link].
Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-Associated Hyponatremia: 2017 Update. Front Med (Lausanne). 2017. 4:21. [QxMD MEDLINE Link].
Lien YH. Antidepressants and Hyponatremia. Am J Med. 2018 Jan. 131 (1):7-8. [QxMD MEDLINE Link].
Lu X, Wang X. Hyponatremia induced by antiepileptic drugs in patients with epilepsy. Expert Opin Drug Saf. 2017 Jan. 16 (1):77-87. [QxMD MEDLINE Link].
Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999 Apr. 106 (4):399-403. [QxMD MEDLINE Link].
Coakley JC, Vervaart PP, McKay MR. Factitious hyponatremia in a patient with cholestatic jaundice following bone marrow transplantation. Pathology. 1986 Jan. 18 (1):158-9. [QxMD MEDLINE Link].
Issa MM, Young MR, Bullock AR, Bouet R, Petros JA. Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century. Urology. 2004 Aug. 64 (2):298-301. [QxMD MEDLINE Link].
Yang CH, Lin YC, Chou PH, Chen HC, Chan CH. A Case Report of Late Onset Mania Caused by Hyponatremia in a Patient With Empty Sella Syndrome. Medicine (Baltimore). 2016 Feb. 95 (6):e2629. [QxMD MEDLINE Link].
Sterns RH. The syndrome of inappropriate antidiuretic hormone secretion of unknown origin. Am J Kidney Dis. 1999 Jan. 33 (1):161-3; discussion 163-5. [QxMD MEDLINE Link].
Pham PC, Pham PM, Pham PT. Vasopressin excess and hyponatremia. Am J Kidney Dis. 2006 May. 47 (5):727-37. [QxMD MEDLINE Link]. [Full Text].
Smith D, Moore K, Tormey W, Baylis PH, Thompson CJ. Downward resetting of the osmotic threshold for thirst in patients with SIADH. Am J Physiol Endocrinol Metab. 2004 Nov. 287 (5):E1019-23. [QxMD MEDLINE Link].
Glassock RJ, Cohen AH, Danovitch G, Parsa KP. Human immunodeficiency virus (HIV) infection and the kidney. Ann Intern Med. 1990 Jan 1. 112 (1):35-49. [QxMD MEDLINE Link].
Palmer BF. Hyponatraemia in a neurosurgical patient: syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting. Nephrol Dial Transplant. 2000 Feb. 15 (2):262-8. [QxMD MEDLINE Link].
Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab. 2003 May-Jun. 14 (4):182-7. [QxMD MEDLINE Link].
Furey AT. Hyponatremia after choledochostomy and T tube drainage. Am J Surg. 1966 Dec. 112 (6):850-5. [QxMD MEDLINE Link].
Skippen P, Adderley R, Bennett M, Cogswell A, Froese N, Seear M, et al. Iatrogenic hyponatremia in hospitalized children: Can it be avoided?. Paediatr Child Health. 2008 Jul. 13 (6):502-6. [QxMD MEDLINE Link].
Thaler SM, Teitelbaum I, Berl T. "Beer potomania" in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998 Jun. 31 (6):1028-31. [QxMD MEDLINE Link].
Goldman MB, Luchins DJ, Robertson GL. Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia. N Engl J Med. 1988 Feb 18. 318 (7):397-403. [QxMD MEDLINE Link].
Danz M, Pöttgen K, Tönjes PM, Hinkelbein J, Braunecker S. Hyponatremia among Triathletes in the Ironman European Championship. N Engl J Med. 2016 Mar 10. 374 (10):997-8. [QxMD MEDLINE Link].
Kratz A, Siegel AJ, Verbalis JG, Adner MM, Shirey T, Lee-Lewandrowski E, et al. Sodium status of collapsed marathon runners. Arch Pathol Lab Med. 2005 Feb. 129 (2):227-30. [QxMD MEDLINE Link].
Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005 Apr 14. 352 (15):1550-6. [QxMD MEDLINE Link].
[Guideline] Hew-Butler T, Almond C, Ayus JC, Dugas J, Meeuwisse W, Noakes T, et al. Consensus statement of the 1st International Exercise-Associated Hyponatremia Consensus Development Conference, Cape Town, South Africa 2005. Clin J Sport Med. 2005 Jul. 15 (4):208-13. [QxMD MEDLINE Link].
Baker J, Cotter JD, Gerrard DF, Bell ML, Walker RJ. Effects of indomethacin and celecoxib on renal function in athletes. Med Sci Sports Exerc. 2005 May. 37 (5):712-7. [QxMD MEDLINE Link].
Budisavljevic MN, Stewart L, Sahn SA, Ploth DW. Hyponatremia associated with 3,4-methylenedioxymethylamphetamine ("Ecstasy") abuse. Am J Med Sci. 2003 Aug. 326 (2):89-93. [QxMD MEDLINE Link].
Feldman BJ, Rosenthal SM, Vargas GA, Fenwick RG, Huang EA, Matsuda-Abedini M, et al. Nephrogenic syndrome of inappropriate antidiuresis. N Engl J Med. 2005 May 5. 352 (18):1884-90. [QxMD MEDLINE Link].
Trivelli A, Ghiggeri GM, Canepa A, Oddone M, Bava G, Perfumo F. Hyponatremic-hypertensive syndrome with extensive and reversible renal defects. Pediatr Nephrol. 2005 Jan. 20 (1):102-4. [QxMD MEDLINE Link]. [Full Text].
Sherlock M, O'Sullivan E, Agha A, Behan LA, Owens D, Finucane F, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J. 2009 Apr. 85 (1002):171-5. [QxMD MEDLINE Link]. [Full Text].
Zenenberg RD, Carluccio AL, Merlin MA. Hyponatremia: evaluation and management. Hosp Pract (1995). 2010 Feb. 38 (1):89-96. [QxMD MEDLINE Link].
Zeidel ML. Hyponatremia: mechanisms and newer treatments. Endocr Pract. 2010 Sep-Oct. 16 (5):882-7. [QxMD MEDLINE Link]. [Full Text].
Silver SM, Kozlowski SA, Baer JE, Rogers SJ, Sterns RH. Glycine-induced hyponatremia in the rat: a model of post-prostatectomy syndrome. Kidney Int. 1995 Jan. 47 (1):262-8. [QxMD MEDLINE Link].
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014 Apr. 29 Suppl 2:i1-i39. [QxMD MEDLINE Link].
George JC, Zafar W, Bucaloiu ID, Chang AR. Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clin J Am Soc Nephrol. 2018 Jul 6. 13 (7):984-992. [QxMD MEDLINE Link].
Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000 May 25. 342 (21):1581-9. [QxMD MEDLINE Link]. [Full Text].
Vachharajani TJ, Zaman F, Abreo KD. Hyponatremia in critically ill patients. J Intensive Care Med. 2003 Jan-Feb. 18 (1):3-8. [QxMD MEDLINE Link]. [Full Text].
Perianayagam A, Sterns RH, Silver SM, Grieff M, Mayo R, Hix J, et al. DDAVP is effective in preventing and reversing inadvertent overcorrection of hyponatremia. Clin J Am Soc Nephrol. 2008 Mar. 3 (2):331-6. [QxMD MEDLINE Link].
Krisanapan P, Vongsanim S, Pin-On P, Ruengorn C, Noppakun K. 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 Aug. 76 (2):203-212. [QxMD MEDLINE Link].
Jovanovich AJ, Berl T. Where vaptans do and do not fit in the treatment of hyponatremia. Kidney Int. 2013 Apr. 83 (4):563-7. [QxMD MEDLINE Link].
Dixon MB, Lien YH. Tolvaptan and its potential in the treatment of hyponatremia. Ther Clin Risk Manag. 2008 Dec. 4 (6):1149-55. [QxMD MEDLINE Link].
Farmakis D, Filippatos G, Kremastinos DT, Gheorghiade M. Vasopressin and vasopressin antagonists in heart failure and hyponatremia. Curr Heart Fail Rep. 2008 Jun. 5 (2):91-6. [QxMD MEDLINE Link].
FDA limits use of tolvaptan due to liver injury risk. Reactions Weekly 2013;1452(1):3-3. 2013.
Rondon-Berrios H, Tandukar S, Mor MK, Ray EC, Bender FH, Kleyman TR, et al. Urea for the Treatment of Hyponatremia. Clin J Am Soc Nephrol. 2018 Nov 7. 13 (11):1627-1632. [QxMD MEDLINE Link].
Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006 Nov 16. 355 (20):2099-112. [QxMD MEDLINE Link].
Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007 Mar 28. 297 (12):1319-31. [QxMD MEDLINE Link].
Santos BC, Chevaile A, Hébert MJ, Zagajeski J, Gullans SR. A combination of NaCl and urea enhances survival of IMCD cells to hyperosmolality. Am J Physiol. 1998 Jun. 274 (6):F1167-73. [QxMD MEDLINE Link].
Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992 Dec 1. 117 (11):891-7. [QxMD MEDLINE Link].
Ruzek KA, Campeau NG, Miller GM. Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging. AJNR Am J Neuroradiol. 2004 Feb. 25 (2):210-3. [QxMD MEDLINE Link].
Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH. Possible causes of central pontine myelinolysis after liver transplantation. World J Gastroenterol. 2004 Sep 1. 10 (17):2540-3. [QxMD MEDLINE Link].
Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK. Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis. 2012 Feb. 59 (2):222-8. [QxMD MEDLINE Link].
Rhee CM, Ayus JC, Kalantar-Zadeh K. Hyponatremia in the Dialysis Population. Kidney Int Rep. 2019 Jun. 4 (6):769-780. [QxMD MEDLINE Link].
Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One. 2015. 10 (4):e0124105. [QxMD MEDLINE Link].

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Table. Guidelines for Management of Hyponatremia

Table. Guidelines for Management of Hyponatremia

	United States Guidelines	European Guidelines
Symptomatic Acute Hyponatremia < 24-48 hours
Urgent correction goal to aim to prevent brain herniation	Increase serum Na+ by 4-6 mmol/L	Increase serum Na+ by 5 mmol/L
Treatment based on symptoms
Severe symptoms	Bolus 100 mL of 3% NaCl over 10 minutes x 3 as needed	Bolus 150 mL of 3% NaCl over 20 minutes, 2- 3 times as needed, checking Na every 20 minutes (First-hour management, regardless of acute or chronic condition)
Moderate symptoms with low risk of herniation	Continuous infusion of 3% NaCl at 0.5-2 mL/kg/h	Bolus 150 mL 3% NaCl over 20 minutes, x 1 to prevent further decrease in Na
Limit not to exceed	None in true acute hyponatremia	None in true acute hyponatremia
Chronic Hyponatremia > 48 hours
Correction rate
Goal in symptomatic patients using hypertonic saline	4-8 mmol/L/d if low risk for ODS 4-6 mmol/L/d if high risk of ODS For patients with severe symptoms, the first day’s increase can be accomplished during first 6 h	Avoid > 10 mmol/L in the first 24 h And > 8 mmol/l during every 24 h thereafter
Limit to avoid potential harm in asymptomatic patients	10-12 mmol/L/d, but max 18 mmol in 48 h if at low risk for ODS 8 mmol/L/d if at high risk of ODS	10 mmol/L in the first 24 h and 8 mmol/l during every 24 h thereafter
Managing Overcorrection of Chronic Hyponatremia
	Baseline serum Na+ ≥ 120 mmol/L: Intervention probably unnecessary	Start once above mentioned limits are exceeded
	Baseline serum Na+ < 120 mmol/L: Replace water orally or as D5W at 3 mL/kg/h with or without desmopressin (2-4 µg every 8 h parenterally) Withhold any vasopressin receptor antagonists (vaptans) used Consider dexamethasone, 4 mg every 6 hr for 24 hr following excessive correction	Consult an expert to discuss infusion containing electrolyte-free water (10 mL/kg) over 1 h with or without 2 µg desmopressin IV every 8 h
Other Treatment Options
Hypovolemic hyponatremia	Isotonic saline	Isotonic saline or balanced solution at 0.5-1.0 mL/kg/h
Euvolemic hyponatremia (SIADH)	Fluid restriction of 500 mL/d below the 24-h urine volume (first-line treatment) Urea, vaptan, or demeclocycline (second-line treatment)	Fluid restriction (first-line) Urea or loop diuretics + oral NaCl (second-line) Do not recommend vaptans Recommend against lithium or demeclocycline
Hypervolemic hyponatremia	Fluid restriction, loop diuretic Vaptans	Fluid restriction Recommend against vaptans and demeclocycine

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Author

Seyed Mehrdad Hamrahian, MD Associate Professor of Medicine (Nephrology), Sidney Kimmel Medical College of Thomas Jefferson University; Director of American Society of Hypertension-Designated Jefferson Hypertension Center; Medical Director, Jefferson Nephrology Outpatient Clinic; Medical Director, Jefferson Home Hemodialysis Program; Medical Director of Chronic Dialysis Unit, DaVita City Line Dialysis

Seyed Mehrdad Hamrahian, MD is a member of the following medical societies: American Heart Association, American Society of Nephrology

Disclosure: Nothing to disclose.

Coauthor(s)

Omar H Maarouf, MD Associate Professor of Medicine, Director of Renal Course, Division of Nephrology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of Acute Dialysis Unit, Associate Program Director of Renal Fellowship, Jefferson Renal Associates, Thomas Jefferson University Hospital

Omar H Maarouf, MD is a member of the following medical societies: American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

Federico J Teran, MD Assistant Professor of Clinical Medicine, Section of Nephrology and Hypertension, Tulane University School of Medicine; Chief of Nephrology, VA Southeast Louisiana Healthcare System

Federico J Teran, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, Louisiana State Medical Society, National Kidney Foundation, Renal Physicians Association

Disclosure: Nothing to disclose.

Eric E Simon, MD Professor of Medicine, Chief, Section of Nephrology and Hypertension, Tulane University School of Medicine; Director, Nephrology Training, Medical Director, Dialysis Clinic, Inc, Canal Street

Eric E Simon, MD is a member of the following medical societies: American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Cell Biology, American Society of Nephrology, Central Society for Clinical and Translational Research, International Society of Nephrology, National Kidney Foundation, Phi Beta Kappa, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

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