• Childhood Kidney Diseases
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• 제8권2호
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• pp.129-137
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• 2004

목적: 일차성 야뇨증에 여러 가지 치료법이 시도되고 있는데 이 중 일반적으로 사용되는 imipramine와 desmopressin 등의 약물요법은 치료효과가 빠르고 비교적 양호하기 때문에 선호하는 치료 방법이다. 그러나 효과가 매우 다양하고 때로는 약물에 의한 부작용으로 인해 사용이 어렵게 되는 경우도 있다. 본 연구에서는 이들 약물을 단독으로 투여한 경우에 비하여 복합투여 할 경우에 치료 효과와 안정성을 비교 평가하여 보다 나은 야뇨증 치료 방법을 제시하고자 하였다. 방법: 2002년 4월부터 2002년 12월까지 내원한 5-l5세 사이의 환자로서 1) 일차성 단일성 야뇨증, 2) 주 2회 이상의 야뇨증, 3) 5세 이상의 연령, 4) 비뇨기과적 이상이 없고, 5) 정신적 또는 신경학적인 증상이 없으며, 6) 내분비 질환이 없고, 7) 최근 2개월 동안 야뇨증 약물치료를 받지 않은 환아로서, 8) 부모의 동의를 받은 경우를 대상으로 하였으며 조건을 만족하는 환자들을 무작위로 선택하여 imipramine 단독투여군, desmopressin 단독투여군과 imipramine과 desmopressin 복합투여군의 3군으로 나누어 야뇨횟수, 부작용과 약물 중단 후 1개월 후 야뇨증 빈도를 확인하였다. 결과: 대상 환아들은 남, 녀 각각 78명과 90명이며, 5-10세가 119명이었고 11-16세는 49명이었다. 치료 시작 4주 이후에서부터 모든 군에서 유의하게 야뇨 횟수가 감소하였다. 치료 종료 시의 imipramine 단독투여군, desmopressin 단독투여군과 imipramine과 desmopressin 복합투여군의 치료율은 각각 68.6%, 74.4%와 86.1%로서 imipramine와 desmopressin 복합투여군의 치료율이 가장 높았으나 통계학적인 차이는 없었다. 치료 종료 후 4주의 야뇨 빈도는 imipramine 단독투여군은 주당 1.9회, desmopressin 단독투여군은 1.3회이고 imipramine와 desmopressin 복합투여군은 1.0회로 세군 사이에는 유의한 차이가 없었다. 약물에 의한 부작용은 imipramine 단독투여군은 20명, desmopressin 단독투여군은 12명, imipramine와 desmopressin 복합투여군13명에서 총 45례에서 나타났는데 이중 imipramine 투여로 인한 식욕 감퇴가 가장 많았다. 결론: 일차성 단일 증상성 야뇨증 치료를 위한 imipramine 단독용법, desmopressin 단독요법, imipramine과 desmopressin 복합요법의 치료효과와 단기간 동안 관찰한 재발 빈도에서는 의미있는 차이는 없어서, 두 약제의 복합요법이 desmopressin 단독 요법에 비해 치료효과, 재발정도와 부작용 빈도에서 차이가 없어 치료 효율성의 우월성을 발견하지 못하였다. 다만 약물 부작용 발생은 imipramine 단독요법이 다른 치료 방법에 비해 발생 빈도가 유의하게 높은 것으로 나타나서 imipramine 단독요법을 할 때에는 부작용 발생유무를 유의해서 관찰하여야 할 것으로 생각된다.

• Journal of Chest Surgery
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• 제23권2호
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• pp.268-274
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• 1990

Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate [DDAVP], synthetic vasopressin analogue that lacks vasoconstrictor activity. In a prospective, randomized trial, we studied the effect of intraoperative desmopressin acetate in 20 patients [the treated group 10 patients and the control group 10 patients] undergoing various cardiac operations requiring cardiopulmonary bypass. The result showed that the early postoperative [during first 24hrs] and mean postoperative blood loss [first 3 days] of the treated group were significantly reduced than the control group[447\ulcorner199ml in the treated group versus 746\ulcorner199ml in the treated group versus 746\ulcorner295 ml in the control group, p=0.014; mean\ulcornerstandard deviation and 675\ulcorner276 ml in the treated group versus 1006\ulcorner303 ml in control group, p=0.019]. The mean red-cell transfusion in first 3days were reduced in the treated group than the control group [3.3\ulcorner1.7 units vs 4.9\ulcorner1.7units, P=0.051]. There were no untoward side effects of desmopressin acetate. We conclude that the administration of desmopressin acetate can be recommended to reduce blood loss and blood conservation in patients undergoing cardiac operations.

• Clinical and Experimental Pediatrics
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• 제59권4호
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• pp.202-204
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• 2016

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

• Childhood Kidney Diseases
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• 제26권2호
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• pp.107-110
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• 2022

Nephrogenic diabetes insipidus, decreased ability to concentrate urine, with production of large amounts of urine, is caused by the refractory response of renal tubules to the action of antidiuretic hormone. This rare disorder, known as X-linked nephrogenic diabetes insipidus, is caused by a mutation in the AVPR2 gene. Because it is hereditary, most patients are male. This report highlights a case of nephrogenic diabetes insipidus in a 3-year 5-month-old female; upon presentation to the hospital, her symptoms included frequent urinationand consumptionof a significant amount ofwater,which had begun2 years ago. The results of blood tests showed increased levels of serum antidiuretic hormone, and sellar magnetic resonance imaging showed no abnormality. The results of the water restriction test and the desmopressin administration test confirmed the diagnosis of nephrogenic diabetes insipidus showing a partial response to desmopressin. The results of genetic testing indicated the presence of an AVPR2 mutation, a heterozygous missense mutation (p.Val88Met), suggesting inheritance of X-linked nephrogenic diabetes insipidus. This report describes a significant case of symptomaticX-linked nephrogenic diabetes insipidus in a female patient who showed a partial response to desmopressin.

• Clinical and Experimental Pediatrics
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• 제51권11호
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• pp.1140-1146
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• 2008

Nocturnal enuresis is a heterogeneous disorder with various underlying pathophysiological mechanisms and causes a mismatch between the nocturnal bladder capacity and the amount of urine produced during sleep at night. It is associated with a simultaneous failure of conscious arousal in response to the sensation of bladder fullness. Generally, a complete history and physical examination, with a specific focus on the genitourinary, gastrointestinal, and neurologic systems, is sufficient to evaluate a patient with enuresis. The therapeutic focus is directed toward a differential approach based on the underlying mechanism and toward combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Children with increased nocturnal urine production usually have a good response to desmopressin therapy. Patients with a small bladder generally show a poor response to desmopressin treatment, but they would benefit more from combination therapy with enuretic alarm, urotherapy, and antimuscarinic agents in addition to desmopressin. Different types of bladder dysfunction, which result in a small nocturnal bladder capacity, probably contribute significantly to the pathogenesis of nocturnal enuresis, particularly in those with treatment failure and refractory symptoms. Because different clinical subgroups may show different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made.

• Journal of Yeungnam Medical Science
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• 제32권2호
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• pp.85-89
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• 2015

Background: We examined the usefulness of urine osmolality, as a predictive factor in the treatment of monosymptomatic nocturnal enuresis (NE) with combination therapy of imipramine and desmopressin. Methods: From May 2014 to April 2015, 59 monosymptomatic NE patients participated in this study. Early morning urine osmolality was measured at 1 week and 1 day before combination therapy of imipramine and desmopressin, and at 1 week and 2 weeks after therapy. The response to combination therapy was evaluated at 3 months after treatment. The mean period of combination therapy was $6.4{\pm}4.2weeks$. Therapeutic response was classified as complete (0-1 wet night/week), partial (over 50% reduction of night) and non-responders (less than 50% reduction of night). Results: The cumulative rate of the complete and partial responders was 76.3%. Among the 3 groups, the statistically lowest value of pre-treatment urine osmolality was observed in the complete responder group (p<0.001). Urine osmolality increased in all groups after treatment, however, statistically the greatest difference between pre and post-treatment urine osmolality was observed in the complete responder group (p=0.024). No serious side effects were observed. Conclusion: Early morning urine osmolality and change of urine osmolality between pre and post-treatment have predictive values in the response to combined imipramine and desmopressin for treatment of monosymptomatic NE.

• Tuberculosis and Respiratory Diseases
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• 제57권3호
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• pp.284-288
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• 2004

폐암에서 중추성 요붕증이 병합되는 경우는 드물며, 그 원인은 대개 뇌하수체로의 전이에 의한 것으로, 이런 경우 수술적 치료나 방사선 치료가 도움이 된다. 그러나 부종양성 증후군의 일부로 발현될 수도 있으며, 이 경우에는 데스모프레신으로 효과적으로 치료할 수 있다. 저자들은 갈증, 다음, 다뇨를 주소로 내원한 비소세포폐암 환자에서 수분제한검사로 중추성 요붕증을 확진한 환자를 경험하였기에 이를 보고하는 바이다.

• 대한한의학회지
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• 제21권1호
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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.

• Childhood Kidney Diseases
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• 제24권1호
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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.

• 한국임상약학회지
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• 제32권2호
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• pp.67-73
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• 2022

Objectives: Hyponatremia is prevalent electrolyte disorder and can be fatal in older adults. Evaluative studies on hyponatremia among older adults are scarce, especially targeting for those who visited emergency department (ED). We aimed to estimate the prevalence and to identify risk factors of hyponatremia among elderly patients visiting the ED. Methods: A retrospective chart review was completed including 65 or older patients who visited ED at Seoul National University Bundang Hospital from September to December 2019. Patients with the serum sodium concentration of less than 130mEq/L was defined as a hyponatremia group. Logistic regression analysis was conducted to assess predictive factors for hyponatremia. Results: Of the total 2,445 patients, 155 (6.3%) were confirmed to have hyponatremia at the time of ED visits. Risk factors for hyponatremia identified in logistic regression analysis were thiazides (aOR=2.64, 95% CI 1.66-4.21), opioids (exclude tramadol) (aOR=3.45, 95% CI 1.72-6.94), and desmopressin (aOR=6.98, 95% CI 2.45-19.84). Compared to the use of thiazides alone, it was confirmed that the possibility of hyponatremia was more than quadrupled when proton pump inhibitor (PPI) was used together (aOR=4.08, 95% CI 1.74-9.55). Conclusions: About 6.3% of older adults visiting the ED had hyponatremia. Age, number of medications taken, previous history of hyponatremia, heart failure, cirrhosis, pneumonia, sepsis, prescribed drugs including thiazides, opioids (exclude tramadol), or desmopressin or taking PPI together with thiazides was confirmed to correlate with the risk of hyponatremia.