II. Pathophysiology

  1. Deficient response by Kidney to Antidiuretic Hormone (ADH)
    1. Contrast with Central Diabetes Insipidus (deficient ADH)
  2. ADH fails increasing collecting duct water permeability
  3. Failed countercurrent mechanism
    1. Inadequate generation of hypertonic interstitium

III. 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

IV. 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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