Nephrogenic Diabetes Insipidus
admin | Jan 14, 2010 | 2 comments
30 years old male presented in opd with the chief complaints of frequency of urination and polydypsia but not polyphagia and weight loss. He is under amphotericin B for fungal infection .On Lab 24 hr urine osmolarity shows less than 300 mosmol/L, the patient has a water diuresis and urine osm is also less so the patient is evaluated under Diabetes insipidus, Desmopressin (10microgam IN tid) is given but no improvement of urine osmolarity so he is diagnosis of Nephrogenic diabetes insipidus and managed with given chlorothiazide.
So my question is, why this patient is treated with the chlorothiazide, which is a diuretic drug?
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Filed Under: Discussion
Thiazide can reduce urine output by inducing a state of mild volume contraction and thereby promoting increase proximal convulated tubular reabsorption of isotonic fluid and inhibiting the generation of free water.
yes I agree with Dr.Madhu,the most widely accepted hypothesis suggests that the antidiuretic action of thiazides is secondary to increased renal sodium excretion . The renal sodium loss causes extracellular volume contraction leading to lowered GFR and increased proximal tubular sodium and water reabsorption. Hence, less water and solutes are delivered to the distal tubule and collecting duct and are lost as urine.thus by symptoms of nephrogenic DI can be controlled with Thiazide treatment.