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Polycystic Kidney Disease Diabetes Insipidus

Diabetes Insipidus

Diabetes Insipidus

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention Definition Diabetes insipidus (DI) is a condition where water in the body is improperly removed from the circulatory system by the kidneys. There are 2 forms of DI: Central diabetes insipidus (central DI) Nephrogenic diabetes insipidus (NDI) Causes Antidiuretic hormone (ADH) controls the amount of water reabsorbed by the kidneys. ADH is made in the hypothalamus of the brain. The pituitary gland, at the base of the brain, stores and releases ADH. Central DI occurs when the hypothalamus does not make enough ADH. NDI occurs when the kidneys do not respond to ADH. Some diabetes insipidus is caused by genetic problems. Most others develop after an injury, illness, or exposure to a medication. Pituitary Gland Risk Factors Factors that may increase your risk of DI include: Central diabetes insipidus (central DI) Damage to the hypothalamus or pituitary glands due to surgery, infection, stroke, brain tumor, or head injury Certain conditions that can infiltrate the brain, such as sarcoidosis, tuberculosis, lymphocytic hypophysitis, and granulomatosis with polyangiitis Most idiopathic or congenital causes result in central DI Diagnosis You will be asked about your symptoms and medical history. A physical exam may be done. Your bodily fluids may be tested. This can be done with: Blood tests Urine tests Water deprivation test Desmopressin challenge test Images may be taken of your bodily structures, usually the urinary tract or brain. This can be done with ultrasound or an MRI scan. Treatment Your doctor will work with you to address the underlying cause. Treatment may include: For central DI—taking a synthetic form of ADH For NDI Drinking plenty of water Treating any underlying cause Following a lo Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body. Often nephrogenic diabetes insipidus is hereditary, but it can be caused by drugs or disorders that affect the kidneys. To treat nephrogenic diabetes insipidus, people restrict salt in their diet and sometimes take drugs to reduce the amount of urine excreted. Both diabetes insipidus and the better-known type of diabetes, diabetes mellitus, result in the excretion of large volumes of urine. Otherwise, the two types of diabetes are very different. Two types of diabetes insipidus exist. Nephrogenic diabetes insipidus and diabetes mellitus are very different, except that both cause people to excrete large amounts of urine. Causes Normally, the kidneys adjust the concentration and amount of urine according to the body’s needs. The kidneys make this adjustment in response to the level of vasopressin in the blood. Vasopressin, which is secreted by the pituitary gland, signals the kidneys to conserve water and concentrate the urine. In nephrogenic diabetes insipidus, the kidneys fail to respond to the signal. Nephrogenic diabetes insipidus may be Hereditary nephrogenic diabetes insipidus In hereditary nephrogenic diabetes insipidus, the gene that typically causes the disorder is recessive and carried on the X chromosome, one of the two sex chromosomes, so usually only males develop symptoms. However, females who carry the gene can transmit the disease to their sons. Rarely, another abnormal gene can cause nephrogenic insipidus in both males and females. Acquired nephrogenic diabetes insipidus Symptoms People may pass from 1 to 6 gallons (3 to 20 lite Continue reading >>

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes insipidus is a condition where the body loses too much fluid through urination, causing a significant risk of dangerous dehydration as well as a range of illnesses and conditions. There are two forms of the disease: nephrogenic diabetes insipidus and central diabetes insipidus (also known as neurogenic diabetes insipidus). A number of factors have been linked to the development of diabetes insipidus, which may also occur in pregnancy or with the use of certain medications. Establishing the cause of the problem can help determine the most appropriate treatment to support the regulation of water balance in the body. Diabetes insipidus is a condition that can be managed successfully. Contents of this article: What is diabetes insipidus? An uncommon condition, diabetes insipidus is a disorder affecting the regulation of body fluid levels. Two key symptoms resemble those of the more common forms of diabetes that affect blood sugar levels (diabetes mellitus types 1 and 2).1-5 People with diabetes insipidus produce excessive amounts of urine (polyuria), resulting in frequent urination and, in turn, thirst (polydipsia). However, the underlying cause of these two symptoms is quite different from the causes in types 1 and 2 diabetes. In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the body's water balance system itself that is not working properly. Here are some key points about diabetes insipidus. More detail and supporting information is in the body of this article. Diabetes insipidus is a condition where the body fails to properly control water balance, resulting in excessive urination. Diabetes insipidus can be caused by low or absent secretion of t Continue reading >>

Nephrogenic Diabetes Insipidus (ndi)

Nephrogenic Diabetes Insipidus (ndi)

Nephrogenic diabetes insipidus (NDI) is a rare disorder that occurs when the kidneys are unable to concentrate urine. In most people, the body balances the fluids you drink with the amount of urine you excrete, or expel, from your body. However, people with NDI produce excessive amounts of urine. This is a condition known as polyuria and it causes insatiable thirst, or polydipsia. NDI occurs when the balance between fluid intake and urine excretion is disrupted. NDI can cause dehydration, among other complications, so it’s important to talk to a doctor if you’re experiencing symptoms. NDI can be fatal if you don’t get treatment for it. The earlier you receive the diagnosis, the better your outlook will be. NDI is unrelated to diabetes mellitus, which is more commonly known as diabetes. The symptoms of NDI vary with age. Infants are severely affected, but the symptoms can resemble many other disorders. As children age, the symptoms become more recognizable. If a diagnosis isn’t made, the symptoms can become severe enough to be life-threatening. You should visit your doctor as soon as possible if you’re experiencing symptoms of NDI. Symptoms in infants The symptoms in infants can include: excessive wet diapers vomiting recurring fevers that have no known cause constipation Symptoms in young children The symptoms in young children can include: bedwetting difficulties in toilet training a failure to thrive mental confusion due to dehydration Symptoms in older children Older children and teenagers can display symptoms that include: high urine output disturbed sleep and fatigue from urinating at night low body weight due to preferring water to food a failure to thrive Symptoms in adults The most common symptoms experienced by adults include: excessive thirst excessi Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted. The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain. DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic means related to the kidney. Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of: Head injury Infection Loss of blood supply to the pituitary gland Surgery Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by: Certain drugs, such as lithium Genetic problems Continue reading >>

A Case For Water In The Treatment Of Polycystic Kidney Disease

A Case For Water In The Treatment Of Polycystic Kidney Disease

A Case for Water in the Treatment of Polycystic Kidney Disease *Mayo Clinic College of Medicine, Rochester, Minnesota; Institut National de la Sant et de la Recherche Medicale, UMRS 872, Centre de Recherche des Cordeliers, Paris, France; University of Kansas Medical Center, Kansas City, Kansas Vicente E. Torres, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905. Phone: 507-266-0541; Fax: 507-266-9315; E-mail: torres.vicente{at}mayo.edu Autosomal dominant polycystic disease (ADPKD) is an inherited disorder characterized by the development within renal tubules of innumerable cysts that progressively expand to cause renal insufficiency. Tubule cell proliferation and transepithelial fluid secretion combine to enlarge renal cysts, and 3-5-cyclic adenosine monophosphate (cAMP) stimulates that growth. The antidiuretic hormone, arginine vasopressin (AVP), operates continuously in ADPKD patients to stimulate the formation of cAMP, thereby contributing to cyst and kidney enlargement and renal dysfunction. Studies in animal models of ADPKD provide convincing evidence that blocking the action of AVP dramatically ameliorates the disease process. In the current analysis, the authors reason that increasing the amount of solute-free water drunk evenly throughout the day in patients with ADPKD and normal renal function will decrease plasma AVP concentrations and mitigate the action of cAMP on the renal cysts. Potential pitfalls of increasing fluid intake in ADPKD patients are considered, and suggestions for how physicians may prudently implement this therapy are offered. Convergent findings in the last decade have established that 3-5-cyclic adenosine monophosphate (cAMP) stimulates mural epithelial cell proliferation and secretion of fluid into cysts of patient 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 >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), a hormone that helps the body conserve the correct amount of water.Diabetes insipidus is not related to the more common type of diabetes called diabetesmellitus. Normally, ADH controls the kidneys' output of urine.ADH is secreted by the hypothalamus (a small gland located at the base of the brain), stored in the pituitary gland and then released into the bloodstream. ADH is secreted to decrease the amount of urine output so that dehydration does not occur. Diabetes insipidus, however,results inexcessive production of very diluted urine and excessive thirst. The disease is categorized into groups based on cause. The groups are described below: Central diabetes insipidus.This condition iscaused byinsufficient production or secretion of pituitary ADH; it can be a result of damage to the hypothalamus or pituitary gland caused by head injuries, genetic disorders, and other diseases. Nephrogenic diabetes insipidus. This condition is the result of alack of kidney response to normal levels of ADH: it can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease. Dipsogenic diabetes insipidus. This conditions is caused by a problem with the thirst feedback mechanism in the hypothalamus. This defect results in abnormal increases in fluid intake and thirst that suppresses ADH production. Gestational diabetes insipidus. This occurs only in pregnant women when an enzyme made by the placenta destroys ADH in the mother. What are the symptoms of diabetes insipidus? The following are the most common symptoms of diabetes insipidus. However, each individual may experience symptoms differently. Symptoms may include: Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

On this page: What is diabetes insipidus? Diabetes insipidus is a rare disorder that occurs when a person's kidneys pass an abnormally large volume of urine that is insipid—dilute and odorless. In most people, the kidneys pass about 1 to 2 quarts of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel the need to drink large amounts of liquids. Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body's inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body. What are the kidneys and what do they do? The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. How is fluid regulated in the body? A person's body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid, although people also lose fluid through sweating, breathing, or diarrhea. The hormone vasopressin, also called antidiuretic hormone, con Continue reading >>

Newly Symptomatic Central Diabetes Insipidus In Esrd With Adult Polycystic Kidneydisease Following Intracranial Hemorrhage: The First Reported Case.

Newly Symptomatic Central Diabetes Insipidus In Esrd With Adult Polycystic Kidneydisease Following Intracranial Hemorrhage: The First Reported Case.

1. Med Sci Monit. 2010 Mar;16(3):CS29-32. Newly symptomatic central diabetes insipidus in ESRD with adult polycystic kidneydisease following intracranial hemorrhage: the first reported case. (1)College of Medicine, Mayo Clinic, Rochester, MN, USA. [email protected] BACKGROUND: Adult polycystic kidney disease (ADPKD), an autosomal dominantlyinherited cause of ESRD, is often characterized by a relative renal tubularunresponsiveness to ADH. Polyuria, renal concentrating defects and generallyelevated ADH levels, a form of nephrogenic diabetes insipidus (NDI) is oftenimplicated. Thus, even late in stages of CKD, ADPKD patients often producesignificant amounts of urine. Conversely, central diabetes insipidus (CDI), aclinical syndrome secondary to deficiency of ADH, also leads to production oflarge volumes of dilute urine, i.e. polyuria. It is widely believed that clinicalCDI is masked in ESRD patients on dialysis, due to apparently obvious reasons.However, there have been published a few reports of the unmasking of polyuriasecondary to previously existing CDI in ESRD patients, after kidneytransplantation.CASE REPORT: We report, to our knowledge, the first case of new-onset symptomaticCDI causing nocturnal polyuria in an ADPKD patient with ESRD, before now onhemodialysis. CDI symptoms were noted, months after an intracranial aneurysmclipping procedure that was complicated by intra-cranial hemorrhage. The 59-year old Caucasian woman responded moderately to desmopressin replacement therapy.CONCLUSIONS: Several interesting pathobiologic implications of this case reportare entertained. Continue reading >>

What Is Diabetes Insipidus?

What Is Diabetes Insipidus?

Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), a hormone that helps the kidneys and body conserve the correct amount of water. Normally, the antidiuretic hormone controls the kidneys' output of urine. It is secreted by the hypothalamus (a small gland located at the base of the brain), stored in the pituitary gland, and then released into the bloodstream. ADH is secreted to decrease the amount of urine output so that dehydration does not occur. Diabetes insipidus, however, causes excessive production of very diluted urine and excessive thirst. The disease is categorized into groups: Central diabetes insipidus. An insufficient production or secretion of ADH; can be a result of damage to the hypothalamus or pituitary gland caused by head injuries, genetic disorders, and other diseases. Nephrogenic diabetes insipidus. A lack of kidney response to normal levels of ADH: can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease. What causes diabetes insipidus? Diabetes insipidus can be caused by several conditions, including the following: Malfunctioning hypothalamus (that produces too little ADH) Malfunctioning pituitary gland (that fails to release ADH into the bloodstream) Damage to hypothalamus or pituitary gland during surgery Brain injury Tumor Blockage in the arteries leading to the brain Encephalitis (inflammation of the brain) Meningitis (inflammation of the meninges, the membranes that cover the brain and spinal cord) Sarcoidosis (a rare inflammation of the lymph nodes and other tissues throughout the body) Family heredity What are the symptoms of diabetes insipidus? The following are the most common symptoms of diabetes insipidus. However, eac Continue reading >>

Clinical Manifestations And Causes Of Nephrogenic Diabetes Insipidus

Clinical Manifestations And Causes Of Nephrogenic Diabetes Insipidus

INTRODUCTION Nephrogenic diabetes insipidus (DI) refers to a decrease in urinary concentrating ability that results from resistance to the action of antidiuretic hormone (ADH). This problem can reflect resistance at the ADH site of action in the collecting tubules, or interference with the countercurrent mechanism due, for example, to medullary injury or to decreased sodium chloride reabsorption in the medullary aspect of the thick ascending limb of the loop of Henle (figure 1) [1]. (See "Diagnosis of polyuria and diabetes insipidus".) Nephrogenic DI, in its mild form, is relatively common since almost all patients who are elderly, sick, or have acute or chronic kidney disease have a reduction in maximum concentrating ability [1]. As an example, the maximum urine osmolality that can be achieved may fall from the normal value of 800 to 1200 mosmol/kg down to 350 to 600 mosmol/kg in these settings [1]. In chronic kidney disease, this defect is due in part to increased solute excretion per functioning nephron and to decreased expression of mRNA for the V2 vasopressin receptor [1,2]. The clinical manifestations and causes of nephrogenic DI will be reviewed here. The treatment of nephrogenic DI, the diagnostic approach to polyuria and diabetes insipidus, and the clinical manifestations and causes of central DI are discussed separately. (See "Treatment of nephrogenic diabetes insipidus" and "Diagnosis of polyuria and diabetes insipidus" and "Clinical manifestations and causes of central diabetes insipidus".) CLINICAL MANIFESTATIONS Patients with moderate to severe nephrogenic or central DI typically present with polyuria, nocturia, and polydipsia. Polyuria is arbitrarily defined as a urine output exceeding 3 L/day in adults or 2 L/m2 in children. Causes of polyuria other than Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus is due to a problem with the kidneys. It is a totally different condition to the better-known diabetes mellitus that involves problems with the pancreas, blood sugar and the way the body uses insulin. In nephrogenic diabetes insipidus the kidneys don't respond to the antidiuretic hormone (ADH) that should regulate fluid balance. This leads to urinating a lot more and being very thirsty. ADH is produced in a part of the brain called the hypothalamus and is stored in the pituitary gland. When the body loses fluid or begins to become dehydrated, ADH is released to tell the kidneys to retain water. This results in a decrease in urination and more concentrated urine. In nephrogenic diabetes insipidus kidneys ignore ADH and keep releasing urine when they should be storing it. The condition can cause a person to become dehydrated and also to have electrolyte imbalances. Symptoms of electrolyte imbalances include: Unexplained weakness Lethargy Muscle pains Irritability Why 'insipidus'? Insipid can mean dull or lacking in flavour. In the olden days, doctors would actually taste urine to diagnose illnesses. With type 1 and type 2 diabetes, urine tastes sweet. With nephrogenic diabetes insipidus it is very watery and lacks any flavour. What causes nephrogenic diabetes insipidus? Children may be born with nephrogenic diabetes insipidus because of an inherited genetic mutation. In adults, the condition can develop as a side effect of certain medications, including lithium for bipolar disorder. Other causes include: High levels of calcium in the blood (hypercalcaemia) Low levels of potassium in the blood ( hypokalaemia) Kidney disease. How is nephrogenic diabetes insipidus treated? If a medication is causing nephrogenic diabetes insipidus a doctor may r Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>

Get Your Full Text Copy In Pdf

Get Your Full Text Copy In Pdf

Newly symptomatic central diabetes insipidus in ESRD with adult polycystic kidney disease following intracranial hemorrhage: the first reported case Background: Adult polycystic kidney disease (ADPKD), an autosomal dominantly inherited cause of ESRD, is often characterized by a relative renal tubular unresponsiveness to ADH. Polyuria, renal concentrating defects and generally elevated ADH levels, a form of nephrogenic diabetes insipidus (NDI) is often implicated. Thus, even late in stages of CKD, ADPKD patients often produce significant amounts of urine. Conversely, central diabetes insipidus (CDI), a clinical syndrome secondary to deficiency of ADH, also leads to production of large volumes of dilute urine, i.e. polyuria. It is widely believed that clinical CDI is masked in ESRD patients on dialysis, due to apparently obvious reasons. However, there have been published a few reports of the unmasking of polyuria secondary to previously existing CDI in ESRD patients, after kidney transplantation. Material and Method: We report, to our knowledge, the first case of new-onset symptomatic CDI causing nocturnal polyuria in an ADPKD patient with ESRD, before now on hemodialysis. CDI symptoms were noted, months after an intracranial aneurysm clipping procedure that was complicated by intra-cranial hemorrhage. The 59-year old Caucasian woman responded moderately to desmopressin replacement therapy. Conclusions: Several interesting pathobiologic implications of this case report are entertained. This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way o Continue reading >>

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