It has been known for many years that patients with chronic renal disease cannot conserve salt as well as normal individuals. However, in 1942 Thorn et al described two patients with chronic renal disease who required a daily intake of 10 to 15 gms of salt in order to maintain salt and water balance.1 These "salt wasters" did not respond to the administration of desoxycorticosterone or antidiuretic hormone, and it was concluded that the salt loss was consequent to a primary failure of tubular reabsorption of sodium. About 20 cases of massive urinary salt loss and renal failure, usually of obscure etiology, have subsequently been described in the literature.
Two patients had multiple myeloma and heavy urinary sodium wasting, and both required an intake of more than 10 gm of salt a day in order to remain in sodium balance.
—A 67-year-old man was admitted