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Diabetes insipidus - nephrogenic
Alternative namesNephrogenic diabetes insipidus; Acquired nephrogenic diabetes insipidus;
DefinitionNephrogenic diabetes insipidus is a disorder characterized by the passage of large volumes of urine due to a defect of the kidney tubules. See also diabetes insipidus-central .
Causes, incidence, and risk factors
Antidiuretic hormone ( ADH ; vasopressin) is a hormone produced in the hypothalamus of the brain. It concentrates the urine by triggering the kidneys to reabsorb water into the blood stream rather than excreting water into the urine.
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.
Excessive amounts of water are excreted with the urine, producing a large quantity of very dilute urine. There is little or no response to vasopressin, even though the blood level of this hormone is higher than normal.
Signs and testsExamination may indicate dehydration and/or shock if fluid intake is inadequate. The pulse rate may be rapid, with a low blood pressure present. The most significant indication of diabetes insipidus is persistent high urine output regardless of fluid intake.
Signs associated with high urine output are:
This disease may also alter the results of the following tests:
The goal of treatment is to regulate fluid levels in the body.
This medication works by causing sodium and water to be excreted in the early part of the renal tubules (the proximal tubules).
This leaves less fluid available for the late portion of the kidney ( distal tubule) to excrete -- this is the portion affected by nephrogenic DI -- and thus it limits the total volume of urine that can be excreted.
Expectations (prognosis)Congenital nephrogenic DI is a chronic condition requiring lifelong treatment. Acquired nephrogenic DI may be short-term or long-term.
Calling your health care providerCall your health care provider if symptoms indicate diabetes insipidus may be present.
PreventionThere is no known prevention for congenital nephrogenic diabetes insipidus. Treatment of causative disorders may prevent some cases of acquired nephrogenic DI. Medications should only be used under the supervision of the health care provider.
Update Date: 1/19/2004Irfan A. Agha, M.D., Department of Medicine, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT