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Nephrogenic Diabetes InsipidusAka: Nephrogenic DI

Definition
1. Deficient response by kidney to Antidiuretic Hormone
Pathophysiology
1. ADH fails increasing collecting duct water permeability
2. Failed countercurrent mechanism
  1. Inadequate generation of hypertonic interstitium
Causes
1. Congenital
2. Chronic disease of renal medulla
  1. Medullary cystic disease
  2. Pyelonephritis
3. Protein deficient diet
4. Salt deficient diet
5. Hypercalcemia
6. Hypokalemia
7. Amyloidosis
8. Multiple Myeloma
9. Medications
  1. Demeclocycline
  2. Lithium
  3. Glyburide
Diagnosis
1. Fluid Deprivation Test
  1. No response to water deprivation
  2. No response to exogenous ADH administration
2. Hare-Hickey Test
  1. Increased ADH to Serum Osmolality ratio

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.