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Diabetes insipidus: Nephrogenic

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What is Diabetes Insipidus – Nephrogenic

Diabetes insipidus (DI) is an uncommon condition that occurs when the kidneys are unable to conserve water as they perform their function of filtering blood. The amount of water conserved is controlled by antidiuretic hormone (ADH, also called vasopressin).
ADH is a hormone produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland, a small gland at the base of the brain.
DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic DI is characterized by a decrease in the ability to concentrate urine due to a resistance to ADH action in the kidney. It occurs less often than central DI.
The major symptoms of diabetes insipidus are excessive urination and extreme thirst. The sensation of thirst stimulates patients to drink large amounts of water to compensate for water lost in the urine.

Statistics on Diabetes Insipidus – Nephrogenic

Nephrogenic DI is a rare disorder. It may be present at birth as a result of a sex-linked defect (congenital nephrogenic DI) that usually affects men, although women can pass the gene on to their children.

Risk Factors for Diabetes Insipidus – Nephrogenic

Most commonly, nephrogenic diabetes insipidus is an acquired disorder. Precipitating factors include drugs (lithium, demeclocycline, amphotericin B), electrolyte disorders (high calcium or low potassium levels), and urinary obstruction.
The specific kidney defect is usually a partial or complete failure of special receptors located on or within the kidney tubules to respond to ADH, the hormone that transmits the instruction to concentrate the urine to the inside of the cells.

Progression of Diabetes Insipidus – Nephrogenic

If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on the fluid and/or electrolyte balance of the body. If inadequate fluids are consumed, the high urine output may cause potentially fatal dehydration and high blood sodium.
Congenital nephrogenic DI is a chronic condition requiring lifelong treatment. Acquired nephrogenic DI may be short-term or long-term.

How is Diabetes Insipidus – Nephrogenic Diagnosed?

The clinician should measure serum electrolytes and glucose, urine specific gravity, urinary sodium, simultaneous serum and urine osmolality, and ADH levels.

Prognosis of Diabetes Insipidus – Nephrogenic

Mortality is rare in adults as long as water is available. Severe dehydration, cardiovascular collapse, and death can ensue in children, elderly people, or in those with complicating illnesses.

How is Diabetes Insipidus – Nephrogenic Treated?

  • The goal of treatment is to regulate fluid levels in the body;
  • All cases should be treated with consistently high fluid intake. The volume of fluids consumed should approximately equal the volume of urine produced;
  • Reduction or discontinuation of medications that may cause nephrogenic DI may improve symptoms;
  • Hydrochlorothiazide may improve symptoms. This may be used alone or in combination with other medications, including indomethacin. Although it is a diuretic hydrochlorothiazide can actually reduce the urine output for people with nephrogenic DI.
    This medication works by causing sodium and water to be excreted in the early part of the renal tubules (the proximal tubules).

Diabetes Insipidus – Nephrogenic References

  1. Cooperman, M. Diabetes Insipidus, 2003 Temple University.
  2. Diabetes insipidus – nephrogenicas retrieved from www.nlm.nih.gov
  3. Koren, A. Diabetes insipidus – nephrogenic. Department of Nephrology NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network
  4. Kumar, P., Clark, M. Clinical Medicine 5th Ed. 2002 WB Saunders.

Drugs/Products Used in the Treatment of This Disease:

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Dates

Posted On: 7 January, 2004
Modified On: 31 May, 2018

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