Nephrogenic diabetes insipidus, the harm is so great

Nephrogenic diabetes insipidus refers to the excretion of large amounts of dilute body fluids from the body. It may be primary, congenital, familial, or secondary and must be treated actively, otherwise hyperosmotic dehydration and electrolyte disorders such as hypokalemia or hypernatremia will occur; there may even be growth and intellectual development disorders.

1. Causes

1. Primary congenital and familial.

2. Secondary

(1) Various chronic kidney diseases (polycystic kidney disease, medullary cystic disease, chronic interstitial disease, severe renal failure).

(2) Obstructive uropathy, after the obstruction is relieved.

(3) Unilateral renal artery stenosis.

(4) After kidney transplantation.

(5) Acute tubular necrosis.

(6) Hypokalemia (including primary aldosteronism).

(7) Chronic hypercalcemia (including hyperparathyroidism).

(8) Drugs (lithium, methoxyflurane, demeclocycline, acetaminophen, amphotericin B, gentamicin, etc.).

(9) Systemic diseases (multiple myeloma, amyloidosis, Sjögren's syndrome, etc.).

2. Complications

1. Bladder distension, ureteral dilatation, hydronephrosis and chronic renal failure. The reason for the complications of the above diseases is due to the long course of the disease and excessive urine volume causing congestion.

2. Hyperosmotic dehydration and electrolyte imbalance, such as hypokalemia or hypernatremia.

3. Growth and intellectual development disorders.

3. Treatment principles

1. The main purpose of symptomatic treatment is to replenish water, maintain water balance, and reduce the intake of solutes such as sugar and salt.

2. Hydrochlorothiazide can affect the distal renal tubule to produce a negative sodium balance, stimulate the proximal tubule to reabsorb sodium, and increase the absorption of water. Hydrochlorothiazide 25-50 mg 3 times a day can be given to reduce urine volume by about 50%.

3. Indomethacin reduces renal blood flow and counteracts the inhibitory effect of prostaglandins on cAMP. It is more effective when used in combination with hydrochlorothiazide. The usual dosage is 25 mg, 3 times a day.