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Experimental and Therapeutic Medicine Jul 2021Nephrogenic diabetes insipidus (NDI) is characterized by impaired urinary concentrating ability, despite normal or elevated plasma concentrations of the antidiuretic... (Review)
Review
Nephrogenic diabetes insipidus (NDI) is characterized by impaired urinary concentrating ability, despite normal or elevated plasma concentrations of the antidiuretic hormone, arginine vasopressin (AVP). NDI can be inherited or acquired. NDI can result from genetic abnormalities, such as mutations in the vasopressin V2 receptor () or the aquaporin-2 (AQP2) water channel, or acquired causes, such as chronic lithium therapy. Congenital NDI is a rare condition. Mutations in are responsible for approximately 90% of patients with congenital NDI, and they have an X-linked pattern of inheritance. In approximately 10% of patients, congenital NDI has an autosomal recessive or dominant pattern of inheritance with mutations in the gene. In 2% of cases, the genetic cause is unknown. The main symptoms at presentation include growth retardation, vomiting or feeding concerns, polyuria plus polydipsia, and dehydration. Without treatment, most patients fail to grow normally, and present with associated constipation, urological complication, megacystis, trabeculated bladder, hydroureter, hydronephrosis, and mental retardation. Treatment of NDI consist of sufficient water intake, low-sodium diet, diuretic thiazide, sometimes in combination with a cyclooxygenase (COX) inhibitor (indomethacin) or nonsteroidal anti-inflammatory drugs (NSAIDs), or hydrochlorothiazide in combination with amiloride. Some authors note a generally favorable long-term outcome and an apparent loss of efficacy of medical treatment during school age.
PubMed: 34055061
DOI: 10.3892/etm.2021.10178 -
AACE Clinical Case Reports 2024
PubMed: 38799043
DOI: 10.1016/j.aace.2024.02.002 -
F1000Research 2017Nocturia is a widespread condition that can negatively impact quality of sleep and overall health. This condition is multifactorial in nature and is best approached... (Review)
Review
Nocturia is a widespread condition that can negatively impact quality of sleep and overall health. This condition is multifactorial in nature and is best approached through the analysis of frequency volume charts. Through these charts, clinicians may classify each individual case of nocturia into one of four distinct categories: global polyuria, nocturnal polyuria, reduced bladder capacity, and mixed. Treatments should then be tailored to each individual based upon the category of their nocturia. In some cases, appropriate therapy will consist of behavioral modification techniques or addressing underlying systemic diseases. In other cases, medical therapy may be necessary, but, to date, medications have shown limited efficacy at treating nocturia.
PubMed: 29026531
DOI: 10.12688/f1000research.11979.1 -
International Journal of Clinical... Nov 2017To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways. (Review)
Review
AIM
To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.
METHODS
A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.
RESULTS
Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management.
CONCLUSIONS
The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.
Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Life Style; Nocturia; Polyuria; Quality of Life
PubMed: 28984060
DOI: 10.1111/ijcp.13027 -
The Pan African Medical Journal 2018
Review
Topics: Adult; Erdheim-Chester Disease; Female; Humans; Immunologic Factors; Interferon-alpha; Polydipsia; Polyuria; Treatment Outcome
PubMed: 29875943
DOI: 10.11604/pamj.2018.29.62.4088 -
Indian Journal of Endocrinology and... 2016Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing... (Review)
Review
Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefits over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.
PubMed: 26904464
DOI: 10.4103/2230-8210.172273 -
BMJ Case Reports Jul 2014A 13-year-old boy presented with fever, skeletal pain, polydipsia, polyuria and multiple osteolytic lesions in pelvic bones and upper femur. There was no organomegaly or...
A 13-year-old boy presented with fever, skeletal pain, polydipsia, polyuria and multiple osteolytic lesions in pelvic bones and upper femur. There was no organomegaly or lymphadenopathy. His serum calcium levels were raised. Peripheral blood film examination was normal. Bone marrow showed presence of blast cells. Flowcytometry indicated B-acute lymphoblastic leukaemia (B-ALL). Hypercalcaemia and osteolytic lesions are rare presentations of B-ALL. This should be kept as a differential if a child presents with unexplained skeletal pain with lytic lesions.
Topics: Adolescent; Bone Marrow; Bone Marrow Examination; Bone and Bones; Humans; Hypercalcemia; Male; Musculoskeletal Pain; Osteolysis; Polydipsia; Polyuria; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Radiography
PubMed: 25006054
DOI: 10.1136/bcr-2014-204050 -
Urology Nov 2019Nocturnal polyuria (NP), the most common etiology of nocturia, can be caused by various medical conditions, including cardiovascular disease, obstructive sleep apnea,... (Review)
Review
Nocturnal polyuria (NP), the most common etiology of nocturia, can be caused by various medical conditions, including cardiovascular disease, obstructive sleep apnea, renal tubular dysfunction, as well as medications (eg, diuretics) and/or behavioral patterns. NP in the absence of underlying medical conditions has been described as NP syndrome and is thought be the result of impaired circadian release of endogenous arginine vasopressin. Desmopressin, a synthetic arginine vasopressin analog, has been shown to be an effective replacement therapy in adults with nocturia due to NP. Further studies on the subset of patients with NP syndrome are warranted to maximize benefit from antidiuretic treatment. In addition, a connection between the pathophysiological mechanisms underlying NP and essential hypertension has been suggested, and hypertension has been shown to be a significant risk factor for nocturia, while an association between NP and brain natriuretic peptide levels has also been reported in patients with nocturia. Hypertension is now viewed as a disorder of blood vessels and treatment is directed at the vasculature rather than the blood pressure, with the latter currently serving as a biomarker for arterial injury. Nocturia is thought to be associated with the beginning of this cardiovascular continuum as studies have reported a link between coronary heart disease and nocturia. Therefore, there is an increasing need to elucidate the complex mechanisms implicated in the association between nocturia and hypertension to promote the development of more individualized therapies for the treatment of nocturia.
Topics: Forecasting; Humans; Hypertension; Natriuretic Peptide, Brain; Nocturia; Polyuria; Prevalence; Vascular Diseases; Vascular Stiffness
PubMed: 31233816
DOI: 10.1016/j.urology.2019.06.014 -
Central European Journal of Urology 2020Desmopressin is an effective and safe therapy for nocturia caused by nocturnal polyuria. However, many physicians are unsure about the proper diagnosis of nocturnal... (Review)
Review
INTRODUCTION
Desmopressin is an effective and safe therapy for nocturia caused by nocturnal polyuria. However, many physicians are unsure about the proper diagnosis of nocturnal polyuria and the identification of patients who may benefit from desmopressin treatment. Therefore, to support urologists in their routine clinical practice, the aim of this study was to provide a comprehensive paradigm for diagnosing nocturnal polyuria with recommendations for the use of desmopressin.
MATERIAL AND METHODS
A multidisciplinary group of experts reviewed the available literature. Findings were compiled into a practice-based approach for workup and treatment.
RESULTS
We designed the nocturia diagnostic pathway to confirm nocturnal polyuria, identify possible causes of nocturnal polyuria, and classify patients with indications and contraindications for desmopressin therapy. A bladder diary remains a basic diagnostic tool. Underlying conditions that may lead to nocturnal polyuria include mainly cardiac insufficiency, arterial hypertension, chronic kidney failure, obstructive sleep apnea, peripheral edema, and excessive fluid intake at night. Treatment for nocturia caused by nocturnal polyuria is based on conservative management and pharmacotherapy, but pharmacological treatment should not precede a prior attempt at conservative treatment. Before administration of desmopressin, patients should be assessed for serum sodium concentration and carefully educated about the symptoms of hyponatremia. Older individuals or persons with risk factors for the development of hyponatremia should be checked regularly for hyponatremia during desmopressin therapy.
CONCLUSIONS
People with nocturia due to nocturnal polyuria should be evaluated carefully before initiating desmopressin treatment. Patients treated with desmopressin should be followed for both clinical efficacy and treatment-related adverse effects.
PubMed: 33552576
DOI: 10.5173/ceju.2020.0283