Non-diabetes symptoms
Non-diabetes mellitus is a disease associated with a lesion of the posterior lobe of the pituitary or hypothalamus with a decrease in the secretion of the antidiuretic hormone. Do not confuse diabetes insipidus with more common diabetes mellitus. Renal diabetes insipidus is characterized by the stability of the kidney in relation to the action of the antidiuretic hormone. Most often, this is a hereditary disease, although its forms can also occur, due to toxic effects on the kidney. This is a fairly rare disease that occurs as a result of insufficient production of vasopressin, which is also known as an antidiuretic hormone( ADH).Vasopressin, released by the posterior lobe of the pituitary gland, helps the kidneys reabsorb water and maintain proper fluid balance. If the pituitary gland is not able to produce enough ADH, the water will not be retained, but will simply pass through the kidneys and be released in very large quantities. In more rare cases, the kidneys will not be able to respond properly to ADH;this disease is known as diabetes insipidus. The main threat to health in any form of diabetes is dehydration. Non-diabetes mellitus is equally common in men and women. With appropriate treatment, the prognosis of the disease is quite favorable( except for cases involving cancer).
Causes of
• In approximately the third part of all cases, the cause of diabetes insipidus is unknown.
• Sometimes hereditary factors can play a role.
• Pituitary injury in head trauma, swelling or inflammation of the hypothalamus, as well as radiation therapy or surgery can lead to diabetes insipidus.
• The most common cause of nephrogenic diabetes insipidus is lithium therapy.
Primary urine enters through the proximal convoluted tubules into the Henle loop. In the ascending section of the Henle loop, active reabsorption of sodium and other osmotically active substances is performed, so that a high level of osmotic pressure is created in the kidney parenchyma. Free water under the laws of osmosis can pass from the lumen of the tubules through their walls in the direction of high osmotic pressure, however changes in the permeability of the tubule make it possible to regulate this process. Regulatory role in this case plays antidiuretic hormone, formed in the posterior lobe of the pituitary gland. Its effect on the permeability of the distal tubules for water is that under its influence it undergoes intensive back absorption, and the amount of daily urine decreases. Cessation of secretion or a decrease in the activity of antidiuretic hormone leads to the fact that the walls of the tubules become impermeable to water, the amount of daily urine increases substantially.
Symptoms of
Hereditary forms of diabetes insipidus manifested in the first 3-6 months of life, although breastfeeding clinical symptomatology appears later than in children who are on early artificial feeding. This is explained by the higher concentration of osmotically active compounds and ions in cow's milk compared with the female one( in 2-3 times).The daily volume of urine even in an infant reaches 2 liters or more.
The first signs of the disease - an increase in body temperature( salt fever) and insufficient weight gain, leading to a decrease in body weight and fluid loss by the body. The baby's skin is dry and marbled, constipation, vomiting are observed. Feeling of thirst in an infant does not manifest, so many children are subjected to unnecessary diagnostic tests and antibiotic treatment. Progression of dystrophy and an increase in the amount of fluid lost lead to disorders of neuropsychological development, in addition, contribute to intracranial hemorrhages and organic brain damage. Many children have frequent diuresis, hyperactivity, lack of attention, anxiety. Behavior improves somewhat when the child's thirst is satisfied. Diuresis is 10-12% of the filtered plasma( normal about 1%).
• Frequent and excessive urination. The urine output can reach 23 to 33 liters in 24 hours and can occur every 30 minutes, even at night.
• Very thirsty.
• Dry skin.
• Constipation.
• Signs of dehydration, including dizziness, weakness and unconsciousness.
Diagnostics
• Physical examination and medical history are necessary. The diagnosis of diabetes insipidus is suggested when the patient reports an unusually frequent urination with a greater urine output.
• Urine test is done to determine whether there is a dilution of urine( low urine density).
• A sample with a water load can be carried out. The patient does not consume any liquid for eight hours, during which the volume and density of the urine output is determined. Patients with diabetes insipidus continue to withdraw a large amount of urine, despite dehydration. In patients with diabetes insipidus associated with insufficient work of the pituitary, the introduction of vasopressin reduces the volume of urine and urine becomes concentrated( in contrast to patients with nephrogenic diabetes insipidus).
• A blood test can be performed to determine the water-salt balance.
A sample with vasopressin( or synthetic analog) does not affect the osmolar concentration of urine( not more than 100 osmol / kg) and to reduce diuresis, which confirms the diagnosis of renal diabetes insipidus. Normally, the response to vasopressin is associated with the activation of membrane adenylate cyclase and increased excretion of cAMP in the urine, which is not observed in renal insipid diabetes. Renin activity in the plasma of patients can be increased, the level of aldosterone at the lower limits of the norm. The kidneys are not macroscopically altered, but histologically, shorter proximal convoluted tubules are found. From the point of view of pathophysiology, three types of polyuria should be distinguished: a violation of ADH secretion, oppression of osmoreceptors and feelings of thirst, defects of renal mechanisms of urine concentration.
Treatment of
• Vasopressin( synthetic ADH) may be used in the form of nasal sprays, pills or injections to replace or supplement the production of ADH by the body. Such hormone therapy is usually necessary to prolong life, although if diabetes insipidus is caused by head trauma or surgery, treatment may be interrupted.
• For the treatment of nephrogenic diabetes insipidus, your doctor can advise a diet low in salt to reduce thirst and slow the excretion of water. Also, some diuretic drugs can be prescribed( nephrogenic diabetes insipidus can not be treated with ADH).
• Drink plenty of fluids to prevent dehydration.
• Consume fibrous food and plenty of fruit juices to prevent constipation.
Prevention of
• Methods for preventing diabetes insipidus are unknown.
• Get medical attention immediately if you have symptoms of diabetes insipidus.
• Attention! Call an "ambulance" if you see that the person next to you loses consciousness.