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Lithium Diabetes Insipidus

Lithium-induced Polyuria And Diabetes Insipidus

Lithium-induced Polyuria And Diabetes Insipidus

Lithium-induced polyuria and diabetes insipidus Polyuria is excessive production of urinemore than 2.5 L/day and even up to 8 L/day.Polyuria may progress to diabetes insipidus. Both polyuria and diabetes insipidus are among the most common side effects of lithium. Polyuria occurs in up to 70% of patients on lithium and diabetes insipidus occurs in between 10 to 20% of patients. These conditions are troublesome to the patient, may affect medication adherence, and in rare cases may lead to irreversible tubular dysfunction. However, active efforts to screen for and manage polyuria/diabetes insipidus are not commonly undertaken. Normally, antidiuretic hormone (ADH; also known as vasopressin) acts on the distal and collecting tubules of the kidney to reabsorb most of the water that was filtered out into the urine. By increasing or decreasing this reabsorption, the body controls the amount of urine produced. But, this process may be impaired due to two main reasons: impaired production of ADH by the pituitary (called central diabetes insipidus) or impairment in the kidneys responsiveness to ADH (called nephrogenic diabetes insipidus). Lithium impairs the effect of antidiuretic hormone on the distal and collecting tubules. This leads to excessively dilute urine. So, what lithium can cause isnephrogenic diabetes insipidus. Trivia: The term Diabetes means excessive urination which is present in both diabetes mellitus and diabetes insipidus. But diabetes mellitus involves excessive production ofurine that is sweet (mellitus) while in diabetes insipidus, the urine is bland in taste (insipid). Lithium-induced polyuria and diabetes insipidus: Treatment Allen HM, Jackson RL, Winchester MD, Deck LV, Allon M. Indomethacin in the treatment of lithium-induced nephrogenic diabetes insipi Continue reading >>

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects Of Amiloride

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects Of Amiloride

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects of Amiloride Jennifer J. Bedford ,* Susan Weggery ,* Gaye Ellis ,* Fiona J. McDonald , Peter R. Joyce , John P. Leader ,* and Robert J. Walker * Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Correspondence: Prof. Robert J. Walker, Continue reading >>

Atorvastatin For The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus

Atorvastatin For The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus

Lithium remains the gold-standard treatment for bipolar disorder, with 30-40% of patients with responding preferentially to this medication. Additionally, lithium is commonly used in treatment-resistant depression, and other psychiatric disorders (e.g. schizoaffective disorder). Lithium is especially valuable considering the great difficulty in achieving and maintaining symptomatic remission, the high rates of disability, as well as tremendous personal, family, and societal costs associated with bipolar disorder and treatment-resistant depression. Despite this, clinicians are increasingly avoiding lithium, largely due to fear of irreversible chronic kidney disease (CKD), particularly in North America. It is well known that lithium exposure, even when dosed safely (<1.0mmol/L in adults 11 and <0.8mmol/L in geriatric patients 12,13), can increase the risk of CKD by 3 times, in large part through Nephrogenic Diabetes Insipidus (NDI) 14-19. NDI itself has also been associated with acute kidney injury 20, and life-threatening hypernatremia, which is an electrolyte imbalance characterized by high levels of blood sodium. Aside from hypertension, diabetes mellitus, aging, and other nonspecific CKD risk factors. NDI is characterized by excessive thirst (polydipsia) due to increased production of dilute urine (polyuria). In NDI, lithium is believed to interact with the inositol monophosphate and protein kinase C pathways, thereby affecting calcium-related intracellular signaling, cyclic AMP (cAMP), inhibition of Glycogen Synthase Kinase-3 Beta (GSK3Beta), activation of MAP Kinase and many other pathways. NDI occurs commonly in lithium users: 50% of chronic lithium users have urinary concentrating difficulties, with 12-19% have decreased urine osmolality (UOsm) <300mOsm/Kg). To da Continue reading >>

Lithium And Chronic Kidney Disease

Lithium And Chronic Kidney Disease

What is lithium? Lithium is a common medicine used to help calm mood for treating people with mental disorders. Since such disorders need lifelong treatment, long-term use of lithium may be harmful to organs, such as the kidneys. How does lithium cause kidney damage? Lithium may cause problems with kidney health. Kidney damage due to lithium may include acute (sudden) or chronic (long-term) kidney disease and kidney cysts. The amount of kidney damage depends on how long you have been taking lithium. It is possible to reverse kidney damage caused by lithium early in treatment, but the damage may become permanent over time. What is nephrogenic diabetes insipidus? The most common problem from taking lithium is a form of diabetes due to kidney damage called nephrogenic diabetes insipidus. This type of diabetes is different than diabetes mellitus caused by high blood sugar. In nephrogenic diabetes insipidus, the kidneys cannot respond to anti-diuretic hormone (ADH), a chemical messenger that controls fluid balance. This results in greater than normal urine out-put and excessive thirst. It can be hard to treat nephrogenic diabetes insipidus. What are the signs and symptoms of kidney damage and nephrogenic diabetes insipidus due to lithium? When the kidneys are not able to control fluid balance you may notice: Greater than normal urine out-put (polyuria), along with greater than normal fluid intake (polydipsia) due to excessive thirst Getting up at night to urinate (nocturia) can be a sign of polyuria Signs of modest dehydration Low blood pressure while standing (orthostatic hypertension) Very fast heart beat (tachycardia) Dry mouth Signs of severe dehydration High blood sodium level (hypernatremia) Change in mental status Too much fluid loss can cause electrolyte imbalance. E Continue reading >>

Causes

Causes

Diabetes insipidus is caused by problems with a chemical called vasopressin (AVP), which is also known as antidiuretic hormone (ADH) . AVP is produced by the hypothalamus and stored in the pituitary gland until needed. The hypothalamus is an area of the brain that controls mood and appetite. The pituitary gland is located below your brain, behind the bridge of your nose. AVP regulates the level of water in your body by controlling the amount of urine your kidneys produce. When the level of water in your body decreases, your pituitary gland releases AVP to conserve water and stop the production of urine. In diabetes insipidus, AVP fails to properly regulate your body's level of water, and allows too much urine to be produced and passed from your body. There are two main types of diabetes insipidus: cranial diabetes insipidus – where the body doesn't produce enough AVP, so excessive amounts of water are lost in large amounts of urine nephrogenic diabetes insipidus – where AVP is produced at the right levels but, for a variety of reasons, the kidneys don't respond to it in the normal way. Possible underlying causes for both types of diabetes insipidus are described below. Cranial diabetes insipidus The three most common causes of cranial diabetes insipidus are: a brain tumour that damages the hypothalamus or pituitary gland a severe head injury that damages the hypothalamus or pituitary gland complications that occur during brain or pituitary surgery No cause can be found for about a third of all cases of cranial diabetes insipidus. These cases, known as idiopathic, appear to be related to the immune system attacking the normal, healthy cells producing AVP. It's unclear what causes the immune system to do this. Less common causes of cranial diabetic insipidus include: Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

Not to be confused with Neurogenic diabetes insipidus. Nephrogenic diabetes insipidus (also known as renal diabetes insipidus) is a form of diabetes insipidus primarily due to pathology of the kidney. This is in contrast to central/neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone (ADH, that is, arginine vasopressin or AVP). Nephrogenic diabetes insipidus is caused by an improper response of the kidney to ADH, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water. Signs and symptoms[edit] The clinical manifestation is similar to neurogenic diabetes insipidus, presenting with excessive thirst and excretion of a large amount of dilute urine. Dehydration is common, and incontinence can occur secondary to chronic bladder distension.[1] On investigation, there will be an increased plasma osmolarity and decreased urine osmolarity. As pituitary function is normal, ADH levels are likely to be abnormal or raised. Polyuria will continue as long as the patient is able to drink. If the patient is unable to drink and is still unable to concentrate the urine, then hypernatremia will ensue with its neurologic symptoms.[citation needed] Causes[edit] Acquired[edit] Nephrogenic DI (NDI) is most common in its acquired forms, meaning that the defect was not present at birth. These acquired forms have numerous potential causes. The most obvious cause is a kidney or systemic disorder, including amyloidosis,[2] polycystic kidney disease,[3] electrolyte imbalance,[4][5] or some other kidney defect.[2] The major causes of acquired NDI that produce clinical symptoms (e.g. polyuria) in the adult are lithium toxicity and high blood calcium. Chronic lithium ingestion – appears to affect the tubules by enterin Continue reading >>

Lithium-induced Diabetes Insipidus: Prevention And Management

Lithium-induced Diabetes Insipidus: Prevention And Management

Lithium-induced diabetes insipidus: Prevention and management Current Psychiatry. 2013 July;12(7):42-45 John Gideon Searle Professor of Clinical and Translational Pharmacy University of Michigan College of Pharmacy and School of Medicine 1. Ecelbarger CA. Lithium treatment and remodeling of the collecting duct. Am J Physiol Renal Physiol. 2006;291(1):F37-38. 2. Christensen BM, Kim YH, Kwon TH, et al. Lithium treatment induces a marked proliferation of primarily principal cells in rat kidney inner medullary collecting duct. Am J Physiol Renal Physiol. 2006;291(1):F39-48. 3. Francis SG, Gardner DG. Basic and clinical endocrinology. 7th ed. New York, NY: McGraw Hill; 2003:154-158. 4. Stone KA. Lithium-induced nephrogenic diabetes insipidus. J Am Board Fam Pract. 1999;12(1):43-47. 5. Grnfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol. 2009;5(5):270-276. 6. Wesche D, Deen PM, Knoers NV. Congenital nephrogenic diabetes insipidus: the current state of affairs. Pediatr Nephrol. 2012;27(12):2183-2204. 7. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York, NY: McGraw-Hill; 2001:754-759,782-783. 8. Batlle DC, von Riotte AB, Gaviria M, et al. Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. N Engl J Med. 1985;312(7):408-414. 9. Earley LE, Orloff J. The mechanism of antidiuresis associated with the administration of hydrochlorothiazide to patients with vasopressin-resistant diabetes insipidus. J Clin Invest. 1962;41(11):1988-1997. 10. Kim GH, Lee JW, Oh YK, et al. Antidiuretic effect of hydrochlorothiazide in lithium-induced nephrogenic diabetes insipidus is associated with upregulation of aquaporin-2, Na-Cl co-transporter, and epithelial sodium channel. J Am Soc Nephrol. 2004;1 Continue reading >>

Lithium Induced Diabetes Insipidus

Lithium Induced Diabetes Insipidus

For those diagnosed with a mental illness or disorder, one of the most effective medications used for treatment is lithium. It is particularly useful when treating conditions such as bipolar disorder. It controls moods effectively, keeps people stable and active, and generally allows for a good quality of life. Over time, however, lithium can also create an unwanted side effect: diabetes insipidus. Lithium induced diabetes insipidus will typically first be discovered on a routine checkup or walk-in appointment, either at the doctor’s office or with the individual’s psychiatrist. The most common complaint is an increased level of thirst, but there may also be unusual daytime fatigue, problems sleeping at night, and even muscle tremors. Why Does Lithium Cause Diabetes Insipidus? Medical science doesn’t actually know why lithium will sometimes cause diabetes insipidus to form. What is known is that lithium works in some way as a counter-agent to the hormone Vasopressin, which acts as an anti-diuretic hormone [ADH]. When lithium is used for an extended period of time, it will desensitize or reduce the ability of the kidney to respond to the ADH that is being produced by the body. This means the kidneys stop listening to the hormones, which is a trademark sign of nephrogenic diabetes insipidus. This creates the need to get up frequently at night to go to the bathroom, which creates insomnia and daytime fatigue. Lithium induced diabetes insipidus is rather common. For those who are receiving long-term lithium therapies, the incidence rate of diabetes insipidus is 40%. How Is Lithium Induced Diabetes Insipidus Diagnosed? Upon presentation, the individual with DI will have an interview that examines their entire medical history. If the disease is supsected, then a water r Continue reading >>

Jci -lithium-induced Nephrogenic Diabetes Insipidus: In Vivo And In Vitro Studies

Jci -lithium-induced Nephrogenic Diabetes Insipidus: In Vivo And In Vitro Studies

The physiological basis for the polyuria and polydipsia occurring in some manic-depressive patients treated with lithium salts was studied in vivo and in vitro. Three lithium-treated polyuric patients, in whom other causes of a concentrating defect were excluded, had abnormal urinary concentrating abilities after a standard water depreviation test. Two of these patients failed to respond to exogenous vasopressin (ADH) and one had a subnormal response. The abilities of these patients to excrete solute-free water (CH2O) was comparable to normal subjects during steady-state water diuresis, suggesting no gross abnormalities in sodium transport. However, each of these patients demonstrated abnormally low capacities to reabsorb solute-free water (TCH2O) under hydropenic conditions after administration of hypertonic saline and vasopressin. These in vivo findings demonstrate at least a nephrogenic basis for the diabetes insipidus syndrome manifested by these three patients. The defect in water transport was further characterized in toad urinary bladders in vitro. Short-circuit current (I) and water flow (W) were studied under basal, ADH-stimulated, and cyclic adenosine 3,5-monophosphate (c-AMP)-stimulated conditions. Increasing mucosal [Li+] progressively inhibited basal I, and both I and W induced by ADH. Significant inhibition of basal and ADH-induced I was observed at mucosal [Li+] < 1.1 mEq/liter, and of ADH-induced W at mucosal [Li+] = 11 mEq/liter. On the other hand, at these lithium concentrations, neither c-AMP-stimulated W nor [] Continue reading >>

Atorvastatin In The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus: The Protocol Of A Randomized Controlled Trial

Atorvastatin In The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus: The Protocol Of A Randomized Controlled Trial

Atorvastatin in the treatment of Lithium-induced nephrogenic diabetes insipidus: the protocol of a randomized controlled trial Lithium is the gold-standard treatment for bipolar disorder, is highly effective in treating major depressive disorder, and has anti-suicidal properties. However, clinicians are increasingly avoiding lithium largely due to fears of renal toxicity. Nephrogenic Diabetes Insipidus (NDI) occurs in 1520% of lithium users and predicts a 23 times increased risk of chronic kidney disease (CKD). We recently found that use of statins is associated with lower NDI risk in a cross-sectional study. In this current paper, we describe the methodology of a randomized controlled trial (RCT) to treat lithium-induced NDI using atorvastatin. We will conduct a 12-week, double-blind placebo-controlled RCT of atorvastatin for lithium-induced NDI at McGill University, Montreal, Canada. We will recruit 60 current lithium users, aged 1885, who have indicators of NDI, which we defined as urine osmolality (UOsm) < 600mOsm/kg after 10-h fluid restriction. We will randomize patients to atorvastatin (20mg/day) or placebo for 12weeks. We will examine whether this improves measures of NDI: UOsm and aquaporin (AQP2) excretion at 12-week follow-up, adjusted for baseline. Lithium remains the gold standard treatment for bipolar disorder and is associated with a better treatment response in 3040% of patients compared to other bipolar pharmacotherapies [ 1 , 2 ]. Lithium is also effective in treatment-resistant depression [ 1 ], has been associated with reduced suicidality [ 3 ], and is even being investigated in a number of neurological conditions such as dementia and stroke [ 4 , 5 ]. Lithium is valuable considering the difficulty in achieving and maintaining symptomatic remission Continue reading >>

Lithium Nephropathy: Practice Essentials, Background, Pathophysiology

Lithium Nephropathy: Practice Essentials, Background, Pathophysiology

Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN more... Lithium is currently a drug of choice for treating persons with bipolar depression and is widely used in this population. Approximately 0.1% of the US population is undergoing lithium treatment for psychiatric problems. Approximately 30% of patients taking lithium experience at least one episode of lithium toxicity. Lithium toxicity can be acute, acute-on-chronic, or chronic. [ 1 ] The acute lithium nephrotoxicity picture is dominated by evidence of volume depletion, obtundation, and the potential for cardiovascular collapse. The chronic lithium nephrotoxicity picture is dominated by polyuria and evidence of chronic kidney disease. See Presentation . Treatment of acute toxicity involves correction of electrolyte abnormalities, volume repletion followed by forced diuresis, and dialysis in severe cases. In patients with chronic toxicity, polyuria can be treated with medication and the chronic renal insufficiency can be treated with the measures routinely used for chronic kidney disease. See Treatment . The medicinal use of lithium has a long and illustrious history. Galen recommended bathing in alkaline mineral waters, which might have contained lithium, for the treatment of mania as early as 200 AD. In the mid-1800s, lithium was proposed as a treatment of uric acid calculi and gout, as uric acid crystals are highly soluble in solutions containing lithium carbonate. This therapy proved ineffective, but lithium was noted to be a highly effective treatment of psychiatric disorders in the late nineteenth century. Unfortunately, the toxicity of lithium severely limited its widespread acceptance at that point. Lithium was used as a substitute and added to the soft drink 7 Up in the early twentie Continue reading >>

Lithium Induced Diabetes Insipidus: Symptoms & Treatment

Lithium Induced Diabetes Insipidus: Symptoms & Treatment

This lesson goes over a relatively complex situation involving one drug and two completely different medical conditions. You'll learn how bipolar disorder, lithium, and diabetes insipidus are all tied together. One Disorder After Another The last thing you want or need when you're sick is another disease or disorder, right? And the last thing you'd expect is that the new disease is caused by the treatment for the first. Unfortunately, this is a possibility in some cases. You'll learn how this is the case in this lesson on lithium-induced diabetes insipidus. What Is Lithium-Induced Diabetes Insipidus? Bipolar disorder, also called bipolar affective disorder or manic-depressive illness, is a type of mental illness characterized by a period of extreme depression followed by a period of elevated or irritable mood called mania. One possible treatment option is a medication called lithium. The problem is lithium has the potential to be nephrotoxic, or poisonous to the kidneys. The kidneys are responsible for regulating the water balance in your body. They do so, in part, by responding to a hormone called antidiuretic hormone (ADH). This hormone is produced in your brain. Once it reaches the kidneys, ADH tells the kidneys to stop making urine and to start preserving water within the body. If the lithium ends up damaging the kidneys, they may no longer respond to ADH as well as they should. This disorder is called nephrogenic diabetes insipidus, or diabetes insipidus whose genesis ('-genic') is a problem in the kidneys ('nephro-'). Symptoms Diabetes insipidus, of any cause, is characterized by two main signs and symptoms: Polyuria - which is production of an excessive volume of urine Polydipsia - which refers to an excessive feeling of thirst and thus the consumption of abnorma Continue reading >>

Indomethacin In The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus

Indomethacin In The Treatment Of Lithium-induced Nephrogenic Diabetes Insipidus

Indomethacin in the Treatment of Lithium-Induced Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus (NDI) is a frequent complication in patients receiving long-term lithium therapy. Both thiazide diuretics and amiloride may reduce the polyuria, but the use of each is associated with problems. We report the results of a clinical trial using the nonsteroidal anti-inflammatory drug indomethacin to treat a patient with well-documented lithium-induced NDI that persisted following cessation of lithium treatment. The administration of a single dose of indomethacin resulted in a dramatic decrease in urine volume and increase in urine osmolality that persisted for several hours, and was independent of renal hemodynamic changes. Subsequently, the patient experienced a sustained, favorable effect on her polyuria during long-term (3 months) indomethacin therapy without a deleterious effect on her renal function. Indomethacin may be a useful therapeutic tool for the amelioration of lithium-induced NDI. (Arch Intern Med. 1989;149:149:1123-1126) Continue reading >>

Alternative Treatment Options For Lithium-induced Nephrogenic Diabetes Insipidus - Sciencedirect

Alternative Treatment Options For Lithium-induced Nephrogenic Diabetes Insipidus - Sciencedirect

Alternative treatment options for lithium-induced nephrogenic diabetes insipidus Author links open overlay panel S.Lpez-Romeo Get rights and content Lithium is currently a drug of choice for treating persons with bipolar disorder and is widely used in this population. Approximately, 30% of patients taking lithium experience at least one episode of lithium toxicity. Treatment of acute toxicity involves correction of electrolyte abnormalities, volume repletion followed by forced diuresis, and dialysis in severe cases. A case report is described and it is reviewed some alternative treatment options before considering withdrawal of lithium treatment in lithium-induced nephrogenic diabetes insipidus. A 58-year-old woman diagnosed of hypertension and bipolar disorder for 20years. At first, she was controlled with valproic acid until she suffered a manic episode which required a mood stabilizer switch. She started a treatment with lithium 1200mg/day and olanzapine to 10mg/day and was completely recovered. After a year of stabilization, olanzapine was retired and she maintained stabilized with lithium 1000mg/day during last 17years. During last 8months, she suffered polydipsia and polyuria (4L/day). She was diagnosed of nephrogenic diabetes insipidus. Some measures like liquid restriction, lithium monodose and low sodium diet were carried out, obtaining a partial response. Taking into account, she was stabilised with lithium for many years, it was decided to introduce hydrochlorothiazide 25mg/day, clinical and analytical resolution of nephrogenic diabetes insipidus was obtained. A year later, she maintains psychopathological stabilization, without any lithium secondary effects. Some treatment options for lithium-induced nephrogenic diabetes insipidus could be introducing thiaz Continue reading >>

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