Diabetes Insipidus (Nephrogenic)

Etiology

  • Decreased renal responsiveness to ADH
  • Results in production of inappropriately dilute urine

Risk Factors

  • Congenital
  • Meds that decrease effect of ADH on kidney→ e.g. Lithium, clozapine, cisplatin
  • Hypercalcemia (link below for more info)
  • Infiltrative diseases affecting the kidney (e.g. sarcoid, amyloid, myeloma)
  • Following resolution of urinary tract obstruction

Symptoms

  • Persistent thirst, drinking large volumes of water, polyuria
  • Degree of DI varies based on how impaired kidney responsiveness is to ADH
  • Decompensation occurs If/when unable to drink enough free water to keep up with urine losses
  • May ultimately develop hypovolemia, confusion, hypernatremia
  • May have symptoms related to process causing hypercalcemia (if that's root cause)

Physical Exam Findings

  • Tachycardia, hypotension, dry mucous membranes (if significant volume depletion)
  • Altered mental status if significant hypernatremia

Sub-Diseases

Tests