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Pharmacological Research May 2014Conformational diseases result from protein misfolding and/or aggregation and constitute a major public health problem. Congenital Nephrogenic Diabetes Insipidus is a... (Review)
Review
Conformational diseases result from protein misfolding and/or aggregation and constitute a major public health problem. Congenital Nephrogenic Diabetes Insipidus is a typical conformational disease. In most of the cases, it is associated to inactivating mutations of the renal arginine-vasopressin V2 receptor gene leading to misfolding and intracellular retention of the receptor, causing the inability of patients to concentrate their urine in response to the antidiuretic hormone. Cell-permeable pharmacological chaperones have been successfully challenged to restore plasma membrane localization of the receptor mutants and to rescue their function. Interestingly, different classes of specific ligands such as antagonists (vaptans), agonists as well as biased agonists of the V2 receptor have proven their usefulness as efficient pharmacochaperones. These compounds represent a potential therapeutic treatment of this X-linked genetic pathology.
Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Diabetes Insipidus, Nephrogenic; Drug Discovery; Humans; Mutation; Protein Conformation; Protein Folding; Receptors, Vasopressin
PubMed: 24239889
DOI: 10.1016/j.phrs.2013.10.007 -
The Korean Journal of Internal Medicine Mar 2014Ifosfamide-induced Fanconi syndrome is a rare complication that typically occurs in young patients due to a cumulative dose of ifosfamide > 40-60 g/m(2), a reduction in... (Review)
Review
Ifosfamide-induced Fanconi syndrome is a rare complication that typically occurs in young patients due to a cumulative dose of ifosfamide > 40-60 g/m(2), a reduction in kidney mass, or concurrent cisplatin treatment. It is usually characterized by severe and fatal progression accompanied by type II proximal renal tubular dysfunction, as evidenced by glycosuria, proteinuria, electrolyte loss, and metabolic acidosis. Diabetes insipidus is also a rare complication of ifosfamide-induced renal disease. We herein describe a case involving a 61-year-old man who developed ifosfamide-induced Fanconi syndrome accompanied by diabetes insipidus only a few days after the first round of chemotherapy. He had no known risk factors. In addition, we briefly review the mechanisms and possible therapeutic options for this condition based on other cases in the literature. Patients who receive ifosfamide must be closely monitored for renal impairment to avoid this rare but fatal complication.
Topics: Acidosis; Antineoplastic Agents, Alkylating; Chemotherapy, Adjuvant; Diabetes Insipidus; Fanconi Syndrome; Fatal Outcome; Histiocytoma, Malignant Fibrous; Humans; Ifosfamide; Male; Middle Aged; Neoadjuvant Therapy; Time Factors
PubMed: 24648810
DOI: 10.3904/kjim.2014.29.2.246 -
Bosnian Journal of Basic Medical... May 2005In this paper we have reviewed the position of desmopressin in the treatment of diabetes insipidus. Desmopressin is a synthetic analog of vasopressin, with more... (Review)
Review
In this paper we have reviewed the position of desmopressin in the treatment of diabetes insipidus. Desmopressin is a synthetic analog of vasopressin, with more pronounced antidiuretic effect. It is treatment of choice in substitution therapy of diabetes insipidus. Its application before sleeping time can reduce nocturnal enuresis, so it has a place in the treatment of enuresis nocturna. Antidiuretic effect of desmopressin is the result of agonistic effect on V2 receptors in the renal tubules. The efficacy and safety of desmopressin in mentioned indications was confirmed in clinical studies.
Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Renal Agents; Safety; Treatment Outcome
PubMed: 16053453
DOI: 10.17305/bjbms.2005.3282 -
Medicine Nov 2023There is a relative wealth of experience in the initial treatment of IgG4-related disease (IgG4-RD), but little is known about therapeutic measures for recurrent cases... (Review)
Review
RATIONALE
There is a relative wealth of experience in the initial treatment of IgG4-related disease (IgG4-RD), but little is known about therapeutic measures for recurrent cases combined with multiple organ and tissue involvement.
PATIENT CONCERNS
A 43-year-old man with a previous diagnosis of IgG4-RD due to recurrent right lacrimal gland enlargement with eyelid erythema presented with diabetes insipidus.
DIAGNOSES
We performed a pituitary Magnetic Resonance Imaging which revealed posterior pituitary rim changes with inhomogeneous enhancement and nodular-like thickening of the pituitary stalk, and performed a water-deprivation-vasopressin test confirmed central diabetes insipidus, and in combination with the patient's elevated IgG4 levels and past medical conditions, we diagnosed central diabetes insipidus, IgG4-related hypophysitis, and IgG4-RD.
INTERVENTIONS
After the patient was admitted to the hospital we gave methylprednisolone 500 mg intravenously once daily for 4 days and again for 4 consecutive days after a 10-day interval. During this period combined with mycophenolate mofetil 250 mg twice daily and desmopressin acetate 0.1 mg 3 times daily.
OUTCOMES
The patient was followed up for a sustained period of 6 months and no side effects of glucocorticoid therapy were noted, there were no signs of recurrence, and the daily urine output stabilized in the normal range.
LESSONS
We recognized that IgG4 levels do not reflect relapse or long-term control, and that glucocorticoid shock therapy is an optional and reliable treatment strategy for relapsed patients.
Topics: Male; Humans; Adult; Glucocorticoids; Diabetes Insipidus, Neurogenic; Immunoglobulin G4-Related Disease; Diabetes Insipidus; Immunoglobulin G; Diabetes Mellitus
PubMed: 37986296
DOI: 10.1097/MD.0000000000036129 -
The Netherlands Journal of Medicine Dec 2020The aetiology of hypotonic polyuria, after excluding solute diuresis, is one of primary polydipsia, central, or nephrogenic diabetes insipidus. Theoretically, these...
The aetiology of hypotonic polyuria, after excluding solute diuresis, is one of primary polydipsia, central, or nephrogenic diabetes insipidus. Theoretically, these disorders should be relatively easily distinguished based on history and the results of an indirect water deprivation test. Practically, however, there is a significant overlap in diagnostic evaluation, potentially leading to an erroneous diagnosis and deleterious management plan. The ability to measure a stimulated copeptin level, either with hypertonic saline or arginine infusion, has led to greater diagnostic accuracy.
Topics: Diabetes Insipidus; Diagnosis, Differential; Glycopeptides; Humans; Polyuria
PubMed: 33380527
DOI: No ID Found -
Nephrologie & Therapeutique Dec 2022We describe here the case of a 54-year-old bipolar woman, followed in psychiatry and treated with lithium and a selective serotonin reuptake inhibitor (escitalopram) and...
We describe here the case of a 54-year-old bipolar woman, followed in psychiatry and treated with lithium and a selective serotonin reuptake inhibitor (escitalopram) and lamotrigine, presenting a lithium poisoning with an altered state of consciousness caused by a supposed mismanagement of her treatment. Lithium poisoning was suggested based on neurological clinical features, but the blood test brought out a lithium concentration within the therapeutic values at 1,2 mmol/L (N: 0,6-1,2 mmol/L). The classic biological complications related to lithium poisoning (hypercalcemia, diabetes insipidus) confirmed the diagnosis. The patient has been transferred to our nephrology department where she got two hemodialysis sessions conducting to clinical and biological improvement, confirming the diagnosis of lithium poisoning despite the normal blood levels. Later, she was transferred to the psychiatry department for follow-up and for treatment adjustment.
Topics: Female; Humans; Middle Aged; Lithium; Lithium Compounds; Hypercalcemia; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic
PubMed: 36163235
DOI: 10.1016/j.nephro.2022.07.398 -
Critical Care Medicine Dec 2019Vasopressin has achieved common usage for the treatment of catecholamine-requiring and catecholamine-resistant shock. Diabetes insipidus is a syndrome characterized by...
OBJECTIVES
Vasopressin has achieved common usage for the treatment of catecholamine-requiring and catecholamine-resistant shock. Diabetes insipidus is a syndrome characterized by excretion of abnormally large volumes of dilute urine. To date, very few reports of diabetes insipidus after discontinuation of vasopressin infusion have been published; the majority of previous reports describe neurosurgical patients. The purpose of the present study was to investigate the occurrence rate of diabetes insipidus after discontinuation of vasopressin infusion among patients treated with vasopressin infusion for shock.
DESIGN
Retrospective analysis of electronic health records of patients receiving continuous vasopressin infusion for the treatment of shock within a 5-year period (2012-2016).
SETTING
Medical, surgical, and cardiothoracic ICUs within one academic medical center.
PATIENTS
One-thousand eight-hundred ninety-six patients received vasopressin infusion for the treatment of shock.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The occurrence rate of diabetes insipidus after discontinuation of vasopressin infusion was 1.53% among all patients. Sixteen of 29 patients with diabetes insipidus after discontinuation of vasopressin infusion had undergone cardiothoracic intervention, such as coronary artery bypass graft and valve replacement surgery, extracorporeal membrane oxygenation, and placement of ventricular assist devices. No neurosurgical patients were identified in our cohort. In a control group of patients receiving norepinephrine but not vasopressin infusion for treatment of shock, criteria for diabetes insipidus were observed in two of 1,320 subjects (0.15%).
CONCLUSIONS
Despite a paucity of published reports, diabetes insipidus after discontinuation of vasopressin infusion appears not to be a rare phenomenon, and is likely to be encountered by intensivists who regularly employ vasopressin for the treatment of vasoplegic shock. Previous reports consisted predominantly of neurosurgical patients. Our findings demonstrate the occurrence of diabetes insipidus after discontinuation of vasopressin infusion among patients with septic shock as well as vasoplegic shock after cardiothoracic intervention. The mechanism of diabetes insipidus after discontinuation of vasopressin infusion remains to be elucidated but may involve transient downregulation of V2 receptors induced by exposure to supraphysiological doses of vasopressin.
Topics: Adult; Child, Preschool; Diabetes Insipidus; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Retrospective Studies; Shock; Vasopressins; Withholding Treatment; Young Adult
PubMed: 31567344
DOI: 10.1097/CCM.0000000000004045 -
BMJ (Clinical Research Ed.) Jan 1989
Review
Topics: Diabetes Insipidus; Humans; Postoperative Complications; Water-Electrolyte Balance
PubMed: 2492841
DOI: 10.1136/bmj.298.6665.2 -
Minerva Anestesiologica Jul 2019Death by neurologic criteria is an irreversible sequence of events culminating in permanent cessation of cerebral functions. In this context, there are no responses... (Review)
Review
Death by neurologic criteria is an irreversible sequence of events culminating in permanent cessation of cerebral functions. In this context, there are no responses arising from the brain, no cranial nerve reflexes nor motor responses to pain stimuli, and no respiratory drive. The diagnosis of death by neurologic criteria implies that there is clinical evidence of the complete and irreversible cessation of brainstem and cerebral functions. The diagnosis, confirmation, and certification of death are core skills for medical practitioners. The aim of this review is to discuss the pathophysiology and definition of death by neurological criteria, describing the clinical assessment, and the use of ancillary tests for the diagnosis of brainstem death.
Topics: Apnea; Brain; Brain Death; Brain Injuries; Brain Stem; Coma; Death; Diabetes Insipidus; Diagnosis, Differential; Disease Progression; Electrodiagnosis; Heart Arrest; Hemodynamics; Hypothalamo-Hypophyseal System; Neuroimaging; Neurologic Examination; Reflex, Abnormal; Reflex, Pupillary; Sympathetic Nervous System
PubMed: 30871303
DOI: 10.23736/S0375-9393.19.13338-X -
Internal Medicine (Tokyo, Japan) 2008
Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Erdheim-Chester Disease; Female; Humans; Skin Diseases
PubMed: 18797126
DOI: 10.2169/internalmedicine.47.1212