Diabetes Insipidus

Definitions and classification of DI

Type Clinical features 
Polyuria 
  • Increased urine output > 3L/day in adults 
  • Etiologies 
    • Diabetes insipidus 
    • High protein diet with urea elimination 
    • Hyperglycemia 
    • Medications (eg, SGLT2 inhibitors, diuretics) 
    • Post-obstructive diuresis 
    • Primary polydipsia 
Central diabetes insipidus (CDI) 
    • ADH also known as vasopressin 
    • Decreased release of antidiuretic hormone (ADH) from pituitary 
  • Affected sites 
    • Hypothalamic osmoreceptors 
    • Superior portion of the supra-optico-hypophyseal tract 
    • Supraoptic or paraventricular nuclei 
Nephrogenic diabetes insipidus (NDI) 
  • Mechanism 
    • Resistance to ADH in collecting tubules of kidney 
  • Affected sites 
    • Collecting tubules 
    • Renal medulla with disrupted countercurrent mechanism 
    • Thick ascending loop of Henle with decreased sodium chloride reabsorption 
(Next Lesson) Central diabetes insipidus (CDI)
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