Kidney diabetes insipidus

Kidney diabetes insipidus includes polyuria, polydipsia and the inability of the kidneys to concentrate urine.

[1], [2], [3], [4], [5],

Causes of the renal insipid diabetes

Renal diabetes insipidus develops due to the lack of sensitivity of epithelial cells of the distal tubules to arginine-vasopressin (antidiuretic hormone), which is mainly due to mutation of the V1 receptor gene of arginine-vasopressin (X-linked form). In addition, the cause is a mutation of the gene encoding the water channel associated with the V2 receptor, aquaporin-2 (an autosomal recessive form of inheritance).

Acquired renal insipid diabetes develops in many diseases.

[6], [7], [8], [9], [10], [11]

Symptoms of the renal insipid diabetes

Primary renal diabetes insipidus is diagnosed in the first week of life.

Symptoms are typical: polyuria, multiple vomiting, convulsions; often expressed dehydration and hyponatremia.

In older children, polyuria, nocturia, polydipsia are found.

Forms

Congenital renal diabetes insipidus

• Mutations of V1-receptor genes of antidiuretic hormone.
• Mutation of the aquaporin-2 gene.

Acquired renal diabetes insipidus

• Medicines:
  • lithium preparations;
  • amphotericin B.
• Nicotine.
• Alcohol.
• Chronic renal failure (especially in the outcome of tubulointerstitial nephritis and obstructive uropathy).
• Sickle-cell anemia.
• Amyloidosis.
• Disease and Sjogren's syndrome.
• Sarcoidosis.
• Hypercalcemia.
• Cystinosis.

[12], [13], [14], [15], [16]

Diagnostics of the renal insipid diabetes

Characteristic increase in the concentrations of sodium, chloride, urea. Typical hyposthenia: the relative density of urine does not exceed 1005.

[17], [18], [19], [20]

Differential diagnosis

Diagnosis is performed using a test with vasopressin. In renal diabetes insipidus, its administration, unlike the pituitary form of the disease, does not cause an increase in the relative density of urine and a decrease in its volume.

[21], [22], [23]

Treatment of the renal insipid diabetes

Treatment consists in the appointment of hydrochlorothiazide, potassium preparations, abundant drinking.

Also justified is the limited sodium intake. Secondary renal diabetes insipidus can be completely eliminated by treatment of the underlying disease.