• Childhood Kidney Diseases
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• v.15 no.2
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• pp.172-178
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• 2011

Nephrogenic diabetes insipidus is a rare genetic renal disease characterized by insensitivity of the kidney to the anti-diuretic effect of vasopressin in spite of elevated serum antidiuretic hormone (ADH). Failure of the kidney to respond to ADH results in impaired osmoregulation and water reabsorption of the kidney, therefore, nephrogenic diabetes insipidus presents with a large amount of hypotonic polyuria, polydipsia, and dehydration. We report our experience of two familial cases of nephrogenic diabetes insipidus in brothers both having c.910+1delG in intron 2 of the AVPR2 gene with the brief review of related literatures.

• The Journal of Korean Medicine
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• v.21 no.1
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• pp.99-102
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• 2000

Central diabetes insipidus(CDI) results from deficient vasopressin(antidiuretic hormone) secretion and causes polydipsia and polyuria. Its etiologic diagnosis is confirmed with an increase of urine osmolality by administering desmopressin(DDAVP) after water restriction. Because cm is caused by deficiency of vasopressin, up to now, desmopressin, a synthetic analog of vasopressin, has been the drug of choice in the treatment of CDI. However, under such treatment, CDI patients suffer from the continual administration of DDAVP throughout one's life and high cost of the treatment We administrated oriental herb medicine on a cm patient in a state of discontinuance of DDAVP. Prior to the study, brain sella MRI was scanned to exclude germinoma. In addition, urine analysis, serum and urinary osmolality, daily urinary volume, serum electrolyte levels were measured. Chungsimyunjatang was administered for 15 days, and urine analysis, urine osmolality, daily urinary volume, serum Na were measured several times again during the therapy, As a result, urinary frequency increased, serum Na slightly elevated, but specific gravity of urine, urinary osmolality severely decreased and daily urinary volume substantially increased. However, the frequency of DDAVP treatment was reduced from four times per day to once or twice a day with the continual administration of the Chungsimyunja-tang for two months after the discharge.

• YAKHAK HOEJI
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• v.26 no.4
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• pp.197-208
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• 1982

In this study attemps were made to obtain evidence as to the action of Mori Radicis Cortex on the renal' function of anesthetized mongrel dogs. 1. A light brown powder isolated from Mori Radicis Cortex (MRC) by a slight modification of Tanemura's method, when given intravenously in doses ranging 0.5 to 5.0mg/kg, elicited diuresis with the increase of positive water clearance and amounts of $Na^{+}$ and $K^{+}$ excreted in the urine. At this time the glomerular filtration rate, renal plasma flow and osmolar clearance were not observed to have any significant changes. This diuresis was augmented in process of time and its maximum effect was exhibited about 30 minutes after administration of MRC. 2. The MRC, when administered into a intra carotid artery, responded promptly with diuresis and natriuresis at a level too small to effect renal functions when administered intravenously. In this experiment the patterns of changes of renal function were the patterns of changes of renal function were the same as those of the above intravenously administered experiment. 3. When infused directly into a renal artery, the MRC exhibited little effect on either kidney. 4. During water diuresis, the MRC did not elicit diuretic action or significant changes in renal functions. The above observations suggest that the diuresis of MRC is brought about by the inhibition of the release of antidiuretic hormone with the mechanism facilitating the excretion of $Na^{+/}$ and $K^{+}$ in urine.

• The Korean Journal of Physiology and Pharmacology
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• v.1 no.3
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• pp.315-323
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• 1997

Central tryptaminergic system has been shown to play an important role in the regulation of renal function: $5-HT_1(5-hydroxytryptamine_1)$ receptors might seem to mediate the diuresis and natriuresis, whereas the $5-HT_2\;and\;5-HT_3$ receptors mediate the antidiuretic and antinatriuretic effects. This study attempted to delineate the role of central $5-HT_{1A}$ subtype in the regulation of rabbit renal function by observing the renal effects of intracerebrovent-ricularly(icv)-administered PAPP(p-aminorhenylethyl-m-trifluoromethytphenyl piperazine, LY165163), a selective agonist of $5-HT_{1A}$ receptors. PAPP in doses ranging from 40 to $350{\mu}g/kg$ icv induced significantly diuresis, natriuresis, and kaliuresis, along with increased renal perfusion and glomerular filtration. Systemic blood pressure was also increased. Free water reabsorption$(T^cH_2O)$, a measure of ADH(antidiuretic hormone) secretion, was increased also. Intravenous $350{\mu}g/kg$ of PAPP elicited antidiuresis and antinatriuresis together with decreased blood pressure, thus indicating that the effects of icv PAPP were brought about through the central mechanisms, not by direct peripheral effects of the drug on kidney. Ketanserin, a selective $5-HT_2$ antagonist, $40{\mu}g/kg$ icv, did not affect the renal effects of the icv PAPP. Methysergide, a non-selective $5-HT_1$ antagonist, also did not block the renal functional responses by the icv PAPP. NAN-190, a $5-HT_{1A}$ antagonist, also did not antagonized the renal action of the icv PAPP. However the increased free water reabsorption was abolished by both methysergide or ketanserin pretreatment. The increments of blood pressure by icv PAPP was blocked only by NAN-190 pretreatment. These observations suggest that the central $5-HT_{1A}$ receptor might be involved in the central regulation of rabbit renal function by exerting the diuretic and natriuretic influences.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.902-905
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• 2002

The most common form of genetic nephrogenic diabetes insipidus(NDI), a rare inherited disorder, is congenital and is transmitted in an X-linked recessive mode. It is refractory to the antidiuretic effect of normal to moderately increased levels of plasma arginine vasopressin(AVP) but, in some cases, may respond to high levels of the hormone or its analogue, deamino-D-arginine vasopressin(DDAVP). X-linked congenital NDI has now been linked to over 128 different mutations in diverse coding regions of the AVP receptor 2(AVPR2) gene. The functional effects of these mutations vary from complete loss of responsiveness to a simple shift to the right in the dose response curve. We report a case of congenital partial NDI, with transversion of A to G at codon 280 of the AVPR2 gene, resulting in a subsequent change of amino acid from tyrosine to cysteine, and that has been effective with hydrochlorothiazide and high dose of DDAVP.

• Childhood Kidney Diseases
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• v.9 no.2
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• pp.269-274
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• 2005

Nephrogenic diabetes insipidus(NBI) is characterized by an inability to concentrate urine despite normal or elevated plasma concentrations of the antidiuretic hormone; arginine vasopressin(AVP). Polyuria with hyposthenuria, and polydipsia are the cardinal clinical manifestations of the disease. Ninety percent of congenital nephrogenic diabetes insipidus patients are males with the X-linked recessive form of the disease; the mutation is in the AVP receptor 2 gene(AVPR2), which is located in chromosomal region Xq28. We report a case of NDI who suffered from unexplained fever and failure to thrive, which has been recognized since about ,3 months after birth. His genomic DNA analysis identified a novel AVPR2 gene mutation as W200C. (J Korean Soc Pediatr Nephrol 2005;9:269-274)

• YAKHAK HOEJI
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• v.40 no.4
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• pp.468-477
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• 1996

Vasopressin which is an antidiuretic hormone in human body produced the diuretic action in dog. This study was investigated in order to certify the diuretic action and to search out the mechanism of the action on the vasopressin. Vasopressin, when given in a dose of 10.0mU/kg, bolus+1.0mU/kg/min intravenously, exhibited the increase of urine flow(Vol), renal plasma flow(RPF), osmolar clearance (Cosm) and amounts of sodium and potassium excreted in urine ($E_{Na},\;E_K$), the decrease of reabsorption rate of sodium and potassium in renal tubules ($R_{Na},\;R_K$), and then elevated the mean arterial pressure(MAP). Vasopressin given in a increased dose to 30.0mU/kg, bolus+1.0mU/kg/min intravenously elicited the same aspect with that exhibited by a small dose in changes of Vol. and all renal function and potentiated the change rates, whereas this time MAP did not change at all when compared with control value. Vasopressin, when administered into a renal artery, did not induce the changes of Vol and all renal function in experimental (administered) kidney, but increased slightly the Vol, glomerular filtration rate(GFR), $E_{Na},\;and\;E_K$ expected the no change of $R_{Na}\;and\;R_K$ in the control (not administered) kidney. Vasopressin, when infused into carotid artery, showed the increase of Vol. GFR, $E_{Na},\;and\;E_K$ and no change of $R_{Na}\;and\;R_K$ in a dose of 1/5 of intravenous dose. Diuretic action of vasopressin administered into carotid artery was not influenced by renal denervation. Above results suggest that vasopressin produced diuretic action by hemodynamic changes in dogs. These hemodynamic changes may be mediated by central endogenous substances not associated with renal nerve.

• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.284-288
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• 2004

Central diabetes insipidus (DI) is a disease caused by insufficient release of antidiuretic hormone. Central DI with lung cancer is very rare. Most of them are caused by the pituitary metastasis, and rarely, by the paraneoplastic syndromes. Central DI is diagnosed by the water deprivation test. The treatment consists of surgical resection, radiotherapy and administration of desmopressin. We report an unusual case of central DI with non-small cell lung cancer. The diagnosis was confirmed by water deprivation test. After the administration of desmopressin, the urine osmolarity was increased. The patient's symptoms and urine osmolarity were improved by intranasal desmopressin.

• Tuberculosis and Respiratory Diseases
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• v.59 no.3
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• pp.306-310
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• 2005

Hyponatremia which is due to excessive sodium loss in the urine and decrease in extracellular fluid volume following an acute or chronic central nervous system injury, has been conjunctively described as cerebral salt wasting syndrome (CSWS). This syndrome is often confused with dilutional hyponatremia due to inappropriate secretion of antidiuretic hormone. Accurate diagnosis and management are mandatory for improvement of the course of the disease. This report describes a case of a 31-year-old male patient with CSWS associated with tuberculous meningitis. The patient exhibited hyponatremia, polyuria, excessive natriuresis, volume depletion, and hypotension. He was diagnosed to manifest CSWS and was treated by administration of fluids, salt, and fludrocortisone. After the respective treatments, symptoms of polyuria and hypotension were gradually resolved and hyponatremia was corrected.

• Childhood Kidney Diseases
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• v.24 no.1
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• pp.42-46
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• 2020

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.