- 1. Central diabetes insipidus
- 2. Nephrogenic diabetes insipidus
- Symptoms of diabetes insipidus
- Treatment for diabetes insipidus
Diabetes insipidus is a disturbance in the concentration of urine, which makes it excess water and causes dehydration and a lot of thirst. This happens by decreasing the production of antidiuretic hormone, or ADH, due to changes in the central nervous system or changes in its action, due to kidney failure.
This diabetes is not part of the types of diabetes mellitus, which are due to increased blood glucose. If you want to know about the types of diabetes mellitus, see here.
Thus, the main causes of diabetes insipidus are:
1. Central diabetes insipidus
Central diabetes insipidus is caused by changes in the region of the brain called the hypothalamus, which loses its ability to produce the hormone ADH, also called vasopressin, and the main causes are:
- Brain surgeries; Cranial trauma; Brain tumor or aneurysm; Autoimmune diseases; Genetic diseases; Infections in the brain; Blockage of blood vessels supplying the brain.
Without adequate levels of ADH stimulated by the brain, the kidneys cannot control the production of urine, which is formed in large quantities, reaching several liters per day.
2. Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus occurs when the concentration of anti-diuretic hormone in the blood is normal but the kidneys do not respond normally to it. The main causes are:
- Use of medications, such as lithium, rifampicin, gentamicin or test contrasts, for example; Polycystic kidney disease; Severe kidney infections; Changes in blood potassium levels; Diseases such as sickle cell anemia, multiple myeloma, amyloidosis, sarcoidosis, for example; Post-kidney transplantation; Kidney cancer; Pregnancy; Causes not clarified or idiopathic.
In addition, there are genetic causes for nephrogenic diabetes insipidus, which are rarer and more serious, since they occur since childhood.
Symptoms of diabetes insipidus
The person with diabetes insipidus has symptoms such as excessive thirst and excess urine, resulting in the need for a large intake of fluids. In addition, over time, excessive fluid consumption causes worsening of sensitivity and less and less production of the anti-diuretic hormone.
Thus, the symptoms are:
- Excessive urine - production of very large volumes of urine especially at night. For example, a 70 kg patient is able to urinate more than 3.5 liters of urine in one day. Uncontrollable thirst - abnormal thirst is stimulated, with a consequent increase in fluid intake.
To diagnose this disease, the doctor must order urine tests to assess its density, in addition to blood tests to assess the values of sodium and potassium. Magnetic resonance imaging of the brain can be done to assess changes in the brain that may be triggering diabetes insipidus.
Treatment for diabetes insipidus
Treatment for diabetes insipidus depends on the severity of each person's disease and the type, which can be cured or persist for some time. Mild and moderate cases can be controlled with a low-salt diet, and use of some thiazide diuretics, which help to control the concentration of urine, with hydrochlorothiazide, for example, or other drugs such as chlorpropamide, carbamazepines or anti-inflammatories.
In more severe cases, and of central cause, the replacement of ADH may be necessary, through the medication desmopressin or DDAVP, which can be administered through the vein, orally or by inhalation.
In addition, when possible, it is important to control the problems that are causing diabetes insipidus, such as the use of medications and infections, for example.
