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Seminars in Nephrology Jul 2023The tubular system of the kidneys is a complex series of morphologic and functional units orchestrating the content of tubular fluid as it flows along the nephron and... (Review)
Review
The tubular system of the kidneys is a complex series of morphologic and functional units orchestrating the content of tubular fluid as it flows along the nephron and collecting ducts. Renal tubules maintain body water, regulate electrolytes and acid-base balance, reabsorb precious organic solutes, and eliminate specific metabolites, toxins, and drugs. In addition, decisive mechanisms to adjust blood pressure are governed by the renal tubules. Genetic as well as acquired disorders of these tubular functions may cause serious diseases that manifest both in childhood and adulthood. This article addresses a selection of tubulopathies and the underlying pathomechanisms, while highlighting the important differences in pediatric and adult nephrology care. These range from rare monogenic conditions such as nephrogenic diabetes insipidus, cystinosis, and Bartter syndrome that present in childhood, to the genetic and acquired tubular pathologies causing hypertension or nephrolithiasis that are more prevalent in adults. Both pediatric and adult nephrologists must be aware of these conditions and the age-dependent manifestations that warrant close interaction between the two subspecialties.
Topics: Humans; Child; Nephrology; Kidney Tubules; Kidney; Diabetes Insipidus, Nephrogenic; Nephrons
PubMed: 37968178
DOI: 10.1016/j.semnephrol.2023.151437 -
Proceedings of the Royal Society of... Jul 1947
Topics: Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Humans
PubMed: 20344524
DOI: No ID Found -
Proceedings of the Royal Society of... Nov 1950
Topics: Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Pituitary Diseases; Pituitary Gland
PubMed: 14797690
DOI: No ID Found -
Einstein (Sao Paulo, Brazil) 2023Diabetes insipidus is a rare disorder characterized by the inability to concentrate urine, which results in hypotonic urine and increased urinary volume. It may occur...
Diabetes insipidus is a rare disorder characterized by the inability to concentrate urine, which results in hypotonic urine and increased urinary volume. It may occur because of antidiuretic hormone deficiency or resistance to its action in the renal tubules. When there is a deficiency in the synthesis of antidiuretic hormones, diabetes insipidus is called central; when there is resistance to its action in the renal tubules, it is said to be nephrogenic. We report a case of idiopathic partial central diabetes insipidus and highlight the management and treatment of the disease.
Topics: Humans; Diabetes Insipidus, Neurogenic; Diabetes Insipidus; Diabetes Mellitus
PubMed: 36790249
DOI: 10.31744/einstein_journal/2023RC0124 -
Journal of Critical Care Apr 2023Vasopressin has become an important vasopressor drug while treating a critically ill patient to maintain adequate mean arterial pressure. Diabetes insipidus (DI) is a... (Review)
Review
PURPOSE
Vasopressin has become an important vasopressor drug while treating a critically ill patient to maintain adequate mean arterial pressure. Diabetes insipidus (DI) is a rare syndrome characterized by the excretion of a large volume of diluted urine, inappropriate for water homeostasis. We noticed that several COVID19 patients developed excessive polyuria suggestive of DI, with a concomitant plasma sodium-level increase and/or low urine osmolality. We noticed a temporal relationship between vasopressin treatment cessation and polyuria periods. We reviewed those cases to better describe this phenomenon.
METHODS
We retrospectively collected COVID19 ECMO patients' (from July 6, 2020, to November 30, 2021) data from the electronic medical records. By examining urine output, urine osmolality (if applicable), plasma sodium level, and plasma osmolality, we set DI diagnosis. We described the clinical course of DI episodes and compared baseline characteristics between patients who developed DI and those who did not.
RESULTS
Out of 37 patients, 12 had 18 episodes of DI. These patients were 7 years younger and had lower severity scores (APACHE-II and SOFA). Mortality difference was not seen between groups. 17 episodes occurred after vasopressin discontinuation; 14 episodes were treated with vasopressin reinstitution. DI lasted for a median of 21 h, with a median increase of 14 mEq/L of sodium.
CONCLUSIONS
Temporary DI prevalence after vasopressin discontinuation in COVID19 ECMO patients might be higher than previously described for vasopressin-treated patients.
Topics: Humans; COVID-19; Critical Illness; Diabetes Insipidus; Polyuria; Retrospective Studies; Sodium; Vasopressins
PubMed: 36630859
DOI: 10.1016/j.jcrc.2022.154211 -
Annals of the Academy of Medicine,... Feb 2021
Topics: Diabetes Insipidus; Diabetes Mellitus; Humans; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 33733264
DOI: 10.47102/annals-acadmedsg.2020418 -
British Medical Journal Apr 1972
Review
Topics: Body Weight; Dehydration; Diabetes Insipidus; Diagnosis, Differential; Humans; Hypertonic Solutions; Injections, Intramuscular; Injections, Intravenous; Isotonic Solutions; Nicotine; Polyuria; Smoking; Sodium Chloride; Sulfonylurea Compounds; Thirst; Vasopressins
PubMed: 4553944
DOI: 10.1136/bmj.2.5807.210 -
Journal of the Royal College of... 1998
Review
Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypoglycemic Agents; Male; Prognosis; Vasopressins
PubMed: 9597622
DOI: No ID Found -
Journal of Veterinary Internal Medicine 2002Nephrogenic diabetes insipidus is caused by an inability of the kidney to concentrate urine despite adequate concentration of vasopressin in blood and is characterized... (Review)
Review
Nephrogenic diabetes insipidus is caused by an inability of the kidney to concentrate urine despite adequate concentration of vasopressin in blood and is characterized by polyuria, polydipsia, and hyposthenuria in the presence of plasma hyperosmolality. Nephrogenic diabetes insipidus is the result of defects in water homeostasis in the kidney. Nephrogenic diabetes insipidus occurs when the kidneys cannot or do not respond to vasopressin. There are 2 categories of nephrogenic diabetes insipidus. Congenital nephrogenic diabetes insipidus is a rare, inherited, irreversible cause of polyuria and polydipsia in humans that is even rarer in animals. Acquired nephrogenic diabetes insipidus is more common and is often secondary to illness or medication that interferes with the action of vasopressin in the renal tubules. Unlike congenital nephrogenic diabetes insipidus, acquired or secondary nephrogenic diabetes insipidus is often reversible with correction of the associated or causative problem.
Topics: Animals; Diabetes Insipidus, Nephrogenic; Humans; Kidney; Vasopressins; Water; Water-Electrolyte Imbalance
PubMed: 12322698
DOI: 10.1892/0891-6640(2002)016<0510:wtitka>2.3.co;2 -
So-called bifocal tumors with diabetes insipidus and negative tumor markers: are they all germinoma?Neuro-oncology Feb 2021The Delphi consensus statements on the management of germ cell tumors (GCTs) failed to reach agreements on the statement that the cases with (i) pineal and...
BACKGROUND
The Delphi consensus statements on the management of germ cell tumors (GCTs) failed to reach agreements on the statement that the cases with (i) pineal and neurohypophyseal bifocal lesion, (ii) with diabetes insipidus, and (iii) with negative tumor markers can be diagnosed as germinoma without histological verification. To answer this, multicenter retrospective analysis was performed.
METHODS
A questionnaire on clinical findings, histological diagnosis, and details of surgical procedures was sent to 86 neurosurgical and 35 pediatrics departments in Japan.
RESULTS
Fifty-one institutes reported 132 cases that fulfilled the 3 criteria. Tissue sampling was performed in 91 cases from pineal (n = 44), neurohypophyseal (n = 32), both (n = 6), and distant (n = 9) lesions. Histological diagnosis was established in 89 cases: pure germinoma or germinoma with syncytiotrophoblastic giant cells in 82 (92.1%) cases, germinoma and mature teratoma in 2 cases, and granulomatous inflammation in 2 cases. Histological diagnosis was not established in 2 cases. Although no tumors other than GCTs were identified, 3 (3.4%) patients had non-germinomatous GCTs (NGGCTs). None of the patients developed permanent complications after endoscopic or stereotactic biopsy. Thirty-nine patients underwent simultaneous procedure for acute hydrocephalus without permanent complications, and hydrocephalus was controlled in 94.9% of them.
CONCLUSION
All patients who fulfilled the 3 criteria had GCTs or granulomatous inflammation, but not other types of tumors. However, no fewer than 3.4% of the patients had NGGCTs. Considering the safety and the effects of simultaneous procedures for acute hydrocephalus, biopsy was recommended in such patients.
Topics: Biomarkers, Tumor; Brain Neoplasms; Child; Diabetes Insipidus; Diabetes Mellitus; Germinoma; Humans; Male; Pineal Gland; Retrospective Studies
PubMed: 32818237
DOI: 10.1093/neuonc/noaa199