Diabetes insipidus is a clinical syndrome resulting from impaired concentration function of the kidneys, which is associated with a deficiency of antidiuretic hormone or impaired sensitivity of the renal tubules to its actions.
Classification
There is the following classification.
1. Central (hypothalamic-hypophysial) diabetes insipidus: 1) idiopathic;
2) symptomatic.
2. Renal diabetes insipidus.
Etiology
The etiology of central diabetes insipidus is unknown, i.e. it is idiopathic diabetes insipidus. In most cases, central diabetes insipidus is symptomatic, that is, it develops in some diseases.
Such diseases can be flu, sore throat, scarlet fever, whooping cough, tuberculosis, syphilis, rheumatism. Also diabetes insipidus can be the result of a craniocerebral injury, electrical injury, hemorrhage in the pituitary gland or hypothalamus.
Also, the disease may be a symptom of a tumor of the hypothalamus or pituitary hypothalamus. As a result of a deficiency of antidiuretic hormone, the concentration function of the kidneys is impaired, which is the release of a large amount of low-density urine.
As a result of stimulation of the thirst center, polydipsia develops in the brain. It leads to an overload of the gastrointestinal tract, which is manifested by irritable bowel syndrome, biliary dyskinesia and gastric ptosis.
Renal diabetes insipidus may be a consequence of the anatomical inferiority of the renal nephron or a defect in the fertile which interferes with the effect of vasopressin on the permeability of the renal tubule membrane to water.
Clinic
The clinic depends on the degree of insufficiency of the antidiuretic hormone. The amount of fluid that the patient absorbs during the day can vary from 3– 40 l and more.
Nicoturia is the first sign of diabetes insipidus in children, and the urine is discolored.
The disease can begin both acutely and gradually, there is a decrease in appetite, body weight, the skin and mucous membranes become dry, the flow and salivation is reduced.
There are violations of the gastrointestinal tract, which is manifested by constipation, the development of colitis and chronic gastritis.
Examination revealed a prolapse and an increase in the size of the stomach, expansion of the bladder, ureters, and renal pelvis.
By reducing the sensitivity of the center of thirst develops dehydration. This condition is manifested by weakness, tachycardia, hypotension, headache, nausea and vomiting, a violation of the rheological properties of blood.
As a result of dehydration, the level of sodium, erythrocytes, hemoglobin and residual nitrogen increases in the blood. When the pathological process progresses, convulsions and psychomotor excitement appear.
In the case of diabetes mellitus, as a result of a pathological process in the brain, a neurological symptomatology develops, which depends on the localization of the pathological focus.
Laboratory research methods
Characteristic of diabetes insipidus is low urine density, which is revealed by a general analysis. Urine density is less than 1.005.
Urine hypoosmolarity is also noted, which is less than 300 mosm / l. When analyzing blood, plasma hyperosmolarity is noted to be greater than 290 mas / l.\
Treatment
Treatment involves the administration of antidiuretin by the intranasal route. The drug is administered 1-3 drops 1-3 times a day.
Treatment should be carried out under the constant control of diuresis and the relative density of urine. If the patient has rhinitis, then antidiuretin is used sublingually.
If diabetes insipidus is nephrogenic, treatment includes the use of thiazide diuretics, non-steroidal anti-inflammatory drugs and lithium drugs.