Materiały źródłowe

• #1 Diabetes insipidus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/diagnosis-treatment/drc-20351274

  Tests used to diagnose diabetes insipidus include: […] Water deprivation test. For this test, you stop drinking fluids for several hours. During the test, your health care provider measures changes in your body weight, how much urine your body makes, and the concentration of your urine and blood. Your health care provider also may measure the amount of ADH in your blood. […] Urine test. Testing urine to see if it contains too much water can be helpful in identifying diabetes insipidus. […] Blood tests. Checking the levels of certain substances in the blood, such as sodium, potassium and calcium, can help with a diagnosis and may be useful in identifying the type of diabetes insipidus. […] Magnetic resonance imaging (MRI). An MRI can look for problems with the pituitary gland or hypothalamus. This imaging test uses a powerful magnetic field and radio waves to create detailed pictures of the brain. […] Genetic testing. If other people in your family have had problems with too much urination or have been diagnosed with diabetes insipidus, your health care provider may suggest genetic testing.

• #2

  https://www.nhs.uk/conditions/diabetes-insipidus/diagnosis/

  See your GP if you have the symptoms of diabetes insipidus. They’ll ask about your symptoms and carry out a number of tests. […] You may be referred to an endocrinologist (a specialist in hormone conditions) for these tests. […] As the symptoms of diabetes insipidus are similar to those of other conditions, including type 1 diabetes and type 2 diabetes, tests will be needed to confirm which condition you have. […] If diabetes insipidus is diagnosed, the tests will also be able to identify the type you have, arginine vasopressin deficiency (AVP-D) or arginine vasopressin resistance (AVP-R). […] A water deprivation test involves not drinking any liquid for several hours to see how your body responds. […] If you have diabetes insipidus, you’ll continue to pee large amounts of dilute urine when normally you’d only pee a small amount of concentrated urine.

• #3 Arginine vasopressin deficiency or resistance (Diabetes insipidus) – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/288

  Arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus) or resistance (AVP-R; previously known as nephrogenic diabetes insipidus) are disorders characterised by polydipsia, polyuria, and formation of inappropriately hypotonic (dilute) urine due to renal water loss. […] AVP-D occurs due to reduced synthesis or release of AVP from the hypothalamo-pituitary axis. AVP-R occurs due to renal insensitivity to AVP. […] Treatment goals are correction and stabilisation of water deficit and electrolyte balance, together with reduction in symptoms of excessive urinary water loss and thirst. […] In AVP-D, the synthetic AVP analogue desmopressin (also known as DDAVP) is the treatment of choice. AVP-R is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria.

• #4 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  How do health care professionals diagnose diabetes insipidus? […] Your health care professional will do a physical exam and ask questions about your health history, including your familys health. Other tests and procedures may include […] Urinalysis. A urinalysis can show if your urine is too diluted, or watery. It can also show if the level of glucose in your blood is too high, which is caused by diabetes mellitus, not diabetes insipidus. […] Blood tests. A blood test can measure sodium levels and the amount of certain substances in your blood, which can help diagnose diabetes insipidus and, in some cases, determine the type. […] Water deprivation test. This test can help health care professionals diagnose diabetes insipidus and identify its cause. The test involves not drinking any liquids for several hours. A health care professional will measure how much urine you pass, check your weight, and monitor changes in your blood and urine. In some cases, the health care professional may give you a man-made version of vasopressin or other medicines during the test.

• #5 Diabetes Insipidus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/117648-overview

  Diabetes insipidus (DI) is defined as the passage of large volumes (3 L/24 hr) of dilute urine ( 300 mOsm/kg). […] If the clinical presentation suggests DI, laboratory tests must be performed to confirm the diagnosis, as follows: A 24-hour urine collection for determination of urine volume, Serum electrolyte concentrations and glucose level, Urinary specific gravity, Simultaneous plasma and urinary osmolality, Plasma ADH level. […] Additional studies that may be indicated include the following: Water deprivation (Miller-Moses) test to ensure adequate dehydration and maximal stimulation of ADH for diagnosis, Pituitary studies, including magnetic resonance imaging (MRI) and measurement of circulating pituitary hormones other than ADH.

• #6 Diabetes Insipidus Workup: Approach Considerations, Water Deprivation Testing, Pituitary Studies

  https://emedicine.medscape.com/article/117648-workup

  In a patient whose clinical presentation suggests diabetes insipidus (DI), laboratory tests must be performed to confirm the diagnosis. A 24-hour urine collection for determination of urine volume is required. In addition, the clinician should measure the following: Serum electrolytes and glucose, Urinary specific gravity, Simultaneous plasma and urinary osmolality, Plasma antidiuretic hormone (ADH) level. […] Water deprivation testing may be useful in situations in which the diagnosis is uncertain. A urinary specific gravity of 1.005 or less and a urinary osmolality of less than 200 mOsm/kg are the hallmark of DI. Random plasma osmolality generally is greater than 287 mOsm/kg. […] Water deprivation followed by the administration of vasopressin may help to differentiate central from nephrogenic DI.

• #7 Diagnostic Testing for Diabetes Insipidus – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537591/

  Once polyuria is confirmed, the next step would be to assess for urinary osmolality. The urine in cases of DI/primary polydipsia is hypotonic. A urine osmolality of 800 mOsm/Kg indicates optimal plasma AVP levels and appropriate renal response to AVP, therefore ruling out any form of DI. […] In individuals with established hypotonic polyuria or in individuals with urine osmolality of 300 mOsm/Kg and 800 mOsm/Kg, further evaluation must be undertaken through laboratory investigations. Serum sodium and plasma osmolality measurements could assist with indicating the type of the underlying polyuric state. A high serum sodium (146 mmol/L) could point towards central or nephrogenic DI while a low normal or low sodium (135 mmol/L) could indicate primary polydipsia as the underlying disorder. […] Diagnosing the type of DI/polyuria-polydipsia syndrome is essential for making the optimal treatment decision. A potential misdiagnosis and the resultant treatment can lead to catastrophic consequences.

• #8 Diagnostic Testing for Diabetes Insipidus – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537591/

  The basic algorithmic approach for diagnosing any suspected case of DI usually involves the following steps: 1. Confirmation of hypotonic polyuria 2. Diagnosis of the type of polyuria-polydipsia syndrome and 3. Identification of the underlying etiology. Performing diagnostic testing in this order can potentially aide with establishing the appropriate diagnosis and with choosing the most relevant biochemical and imaging tests. […] The first step is to confirm if a patient indeed has polyuria. Complaints of polyuria can often be a misrepresentation of the actual symptoms of urinary urgency, nocturia, urinary incontinence, urinary tract infection, or prostatic hypertrophy. Once these symptoms have been ruled out, a 24-hour urine collection should be obtained. A 24-hour urine volume of 2.5 L could be reassuring and there is no concern for osmoregulatory disruption.

• #9 Diagnostic Testing for Diabetes Insipidus – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537591/

  The water deprivation test is also known by the terms indirect water deprivation test and dehydration test. The term indirect is utilized as this test generally does not involve direct measurements of plasma AVP to diagnose and differentiate the various forms of DI. The water deprivation test is almost always followed with desmopressin administration to further characterize the type of polyuric polydipsic state. […] The dehydration phase is initiated overnight among those patients in whom this phase is performed as an out-patient. The timing of initiation of overnight water deprivation for out-patient testing is determined based on the 24-hour urine output of the patient, with a goal of achieving approximately 3% loss of body weight. […] The next phase of the test is the desmopressin phase, which involves administration of desmopressin following dehydration. This phase can be initiated if either one of the following end-points are achieved: 1. Dehydration phase is completed for 8 hours, 2. Two consecutive urine osmolality measures do not differ by 10% and loss of 2% body weight, 3. Premature termination of dehydration phase due to loss of more than 3% of body weight, elevation of serum sodium to above normal limits, or intractable thirst.

• #10 Diabetes Insipidus (DI): Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/diabetes/what-is-diabetes-insipidus

  Water deprivation test. This measures the changes in your body weight, blood sodium, and urine concentration after you dont drink anything for a while. There are two types: a short-form test that can be done at home and a formal test that is done in the hospital. During the long test, your doctor will closely measure your blood pressure, heart rate, and body weight. At the end of the test which usually lasts about 12 hours, your doctor will sometimes give you a dose of man-made vasopressin to help figure out which type of diabetes insipidus you have. […] MRI. This test takes detailed pictures of your internal organs and soft tissues. The doctor uses it to see if theres a problem with your hypothalamus or pituitary gland. […] Genetic screening. Your doctor may suggest this test if your family members have had problems with making too much urine.

• #11 Diabetes insipidus

  https://www.rch.org.au/clinicalguide/guideline_index/diabetes_insipidus/

  Children with suspected or known diabetes insipidus (DI) must always have free access to water. Never restrict fluid intake […] Close monitoring of electrolytes and fluid balance is required for inpatients with DI. This is particularly critical when children are too young or too unwell to adequately respond to thirst […] Urgent BGL (to exclude Diabetes mellitus) […] A water deprivation test will distinguish central DI from nephrogenic DI and primary polydipsia. This test should only be performed under specialist guidance, and may not be appropriate for infants 12 months due to safety […] All children should be discussed with endocrinology before starting or modifying desmopressin treatment […] All children should be managed in conjunction with a paediatric nephrologist and dietician

• #12 Diagnostic Testing for Diabetes Insipidus – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537591/

  In normal individuals, with dehydration, the urine osmolality usually increases up to 800 1200 mOsm/Kg. If the dehydration phase is begun at 12:00 am, a morning (8:00 – 9:00 am) urine osmolality of 800 1200 mOsm/Kg excludes DI. A urine osmolality of 300 mOsm/Kg with a concomitant plasma osmolality of 300 mOsm/Kg or a sodium level above upper limit of normal following dehydration is suggestive of either central or nephrogenic DI. […] The indirect water deprivation test is the most well tested and widely utilized as the standard diagnostic test for DI. Adjunctive measurements of plasma AVP or copeptin levels can enrich the diagnostic yield of the water deprivation test. […] The major advantage with the hypertonic saline infusion test is that it basically excludes the renal component out of the equation and any potential down-regulation of aquaporin-2 channels will not affect the diagnosis. This test depends only on two aspects: 1. Increasing the plasma osmolality, which is a strong stimulus for endogenous AVP synthesis and release and 2. Measurement of endogenous AVP secretory capacity by measuring plasma copeptin, which is secreted in equimolar proportions from the posterior pituitary along with AVP. […] Once the type of polyuria-polydipsia syndrome is identified, efforts must be undertaken to diagnose the underlying pathology responsible for this clinical presentation.

• #13

  https://www.nhs.uk/conditions/diabetes-insipidus/diagnosis/

  You may also need a blood test to assess the levels of antidiuretic hormone (ADH) in your blood. […] If you have diabetes insipidus, your urine will be very dilute, with low levels of other substances. […] After the water deprivation test, you may be given a small dose of vasopressin (AVP), usually as an injection. […] This will show how your body reacts to the hormone, which helps to identify the type of diabetes insipidus you have. […] If the dose of AVP stops you peeing urine, it’s likely your condition is the result of a shortage of AVP. […] If you continue to pee despite the dose of AVP, this suggests there’s already enough AVP in your body, but your kidneys are not responding to it. […] You may need an MRI scan if your endocrinologist thinks you have cranial diabetes insipidus as a result of damage to your hypothalamus or pituitary gland.

• #14 Get Diabetes Insipidus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/diabetes-insipidus-treatment

  Vasopressin test: After a water deprivation test, we give you a vasopressin (ADH) injection (Pitressin or Vasostrict). If it causes you to stop peeing, you probably have central diabetes insipidus. If you keep peeing, you probably have nephrogenic diabetes insipidus. […] Blood tests: We look for low ADH levels in your blood, which can indicate diabetes insipidus. These tests can also rule out diabetes mellitus and other conditions that cause you to drink and pee a lot. […] Urinalysis: This test checks the concentration and contents of your urine. […] Imaging exams: Imaging exams like an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) help us look for hypothalamus or pituitary gland damage.

• #15 Diabetes Insipidus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetes-insipidus-pro

  […] […] Classification of causes of diabetes insipidus on basis of water deprivation and DDAVP response […] […] […] Urine osmolality after fluid deprivation (mOsm/kg) […] Urine osmolality after DDAVP (mOsm/kg) […] Likely diagnosis […] 300 […] 800 […] Cranial DI […] 300 […] 300 […] Nephrogenic DI […] 800 […] 800 […] Primary/psychogenic polydipsia […] 300 […] 800 […] Partial cranial DI or nephrogenic DI or PP or diuretic abuse

• #16 ArginineVasopressin Deficiency (Central Diabetes Insipidus) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/argininevasopressin-deficiency-central-diabetes-insipidus

  Argininevasopressin deficiency (central diabetes insipidus) is a lack of the hormone vasopressin (antidiuretic hormone) that causes excessive production of very dilute urine (polyuria). […] The diagnosis is based on urine tests, blood tests, and a water deprivation test. […] The water deprivation test is the best test to diagnose argininevasopressin deficiency. […] The diagnosis of argininevasopressin deficiency is confirmed if, in response to vasopressin, the person’s excessive urination stops, the urine becomes more concentrated, the blood pressure rises, and the heart beats more normally. […] Doctors sometimes measure the level of circulating vasopressin or copeptin (a piece of the vasopressin hormone) in the blood to confirm argininevasopressin deficiency. However, vasopressin and copeptin levels are difficult to measure, and the tests are not routinely available. […] Additionally, the water deprivation is so accurate that direct measurement of vasopressin or copeptin is usually unnecessary.

• #17 Diabetes insipidus

  https://www.rcpa.edu.au/Manuals/RCPA-Manual/Clinical-Presentations-and-Diagnoses/D/Diabetes-insipidus

  In the appropriate clinical context, the diagnosis can be established from Osmolality, Sodium, Osmolality urine and Sodium urine. Plasma Copeptin or Antidiuretic hormone assay may sometimes be of use. […] If necessary, a water deprivation test provides the definitive diagnosis, but it must be performed as a hospital procedure under medical supervision, this may include measurement of Copeptin or Antidiuretic hormone.

• #18 Diabetes Insipidus Workup: Approach Considerations, Water Deprivation Testing, Pituitary Studies

  https://emedicine.medscape.com/article/117648-workup

  A prospective study by Winzeler et al indicated that measurement of plasma copeptin at baseline and following arginine stimulation may be an effective means of differentiating DI from primary polydipsia. […] A single-center, retrospective study by Gippert et al indicated that arginine-stimulated copeptin can also be used in the diagnosis of central DI in pediatric patients. […] Historically, diagnostic tests in DI can be traced back to the 1930s, when Gilman and Goodman first demonstrated recovery of an antidiuretic substance in the urine of rats following dehydration with hypertonic saline. […] The water deprivation test (ie, the Miller-Moses test), a semiquantitative test to ensure adequate dehydration and maximal stimulation of ADH for diagnosis, is typically performed in patients with more chronic forms of DI.

• #19

  https://smw.ch/index.php/smw/article/view/2792

  Polyuria-polydipsia syndrome consists of the three main entities: central or nephrogenic diabetes insipidus and primary polydipsia. Reliable distinction between these diagnoses is essential as treatment differs substantially, with the wrong treatment potentially leading to serious complications. […] With the establishment of copeptin, a stable and reliable surrogate marker for arginine vasopressin, diagnosis of the polyuria-polydipsia syndrome has been newly evaluated. […] Whereas unstimulated basal copeptin measurement reliably diagnoses nephrogenic diabetes insipidus, two new tests using stimulated copeptin cutoff levels showed a high diagnostic accuracy in differentiating central diabetes insipidus from primary polydipsia. […] The test protocols of the two tests are provided and a new copeptin-based diagnostic algorithm is proposed to reliably differentiate between the different entities. […] Furthermore, the role of copeptin as a predictive marker for the development of diabetes insipidus following surgical procedures in the sellar region is described. […] A Copeptin-Based Approach in the Diagnosis of Diabetes Insipidus.

• #20 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to make pictures of your brain tissues. Your health care professional may order this test to look for damage to your hypothalamus or pituitary gland that could cause diabetes insipidus. […] Stimulation tests. During these tests, you are given an intravenous solution that stimulates your body to produce vasopressin. A health care professional then measures your blood level of copeptin, a substance that increases when vasopressin does. Results can indicate if you have diabetes insipidus or a different condition called primary polydipsia, which can cause you to drink lots of liquids.

• #21 Diabetes Insipidus & Other Related Conditions | Histiocytosis Association

  https://histio.org/histiocytic-disorders/diabetes-insipidus-other-related-conditions/

  A water deprivation test is a complicated procedure that requires specially trained medical professionals. It should be done in a controlled setting where the patient can be monitored closely throughout the entire test. The water deprivation test measures changes in body weight, urine output, and the make-up of the urine, and levels of salts in the blood when fluids are withheld and as dehydration occurs. Measuring blood levels of the hormone ADH is also usually performed. Samples are taken every hour over a several-hour period. […] An x-ray test called an MRI scan may be done to look for abnormalities in the pituitary gland, although alone, this is not diagnostic of diabetes insipidus. However, at diagnosis, it is estimated that 71% of patients show an abnormally thickened pituitary stalk on MRI.

• #22 International expert consensus statement on the diagnosis and management of congenital nephrogenic diabetes insipidus (arginine vasopressin resistance) | Nature Reviews Nephrology

  https://www.nature.com/articles/s41581-024-00897-z

  The initial work-up consists of measuring serum sodium, serum osmolality and urine osmolality. […] The detection of inappropriately diluted urine (that is, urinary osmolality 200mOsm/kg H2O), in combination with high-normal or elevated serum sodium is pathognomonic for the diagnosis of diabetes insipidus (nephrogenic or central) and warrants early genetic testing if NDI is suspected. […] We recommend, when possible, starting the diagnostic process with genetic testing in all patients with clinical and biochemical symptoms of NDI. […] We recommend early genetic testing in a patient with clinical symptoms of suspected NDI. […] We recommend genetic testing using umbilical cord blood in male offspring of a known heterozygote female carrier of an AVPR2 mutation. […] We recommend performing genetic testing in laboratories accredited for diagnostic genetic testing.

• #23 Diagnostic Testing for Diabetes Insipidus – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537591/

  Diagnosing the type of DI/polyuria-polydipsia syndrome is essential for making the optimal treatment decision. A potential misdiagnosis and the resultant treatment can lead to catastrophic consequences. For instance, if primary polydipsia is misdiagnosed as central DI and desmopressin treatment is initiated, severe hyponatremia can occur. There have been several tests that have been developed over the past century to diagnose the presence of DI and to differentiate the various types of polyuria-polydipsia syndromes. This chapter specifically comprises the description of different diagnostic tests utilized in the diagnosis of these conditions. […] The major challenge with diagnosing and classifying the type of DI arises from the fact that the various forms of polyuria-polydipsia syndromes can show overlapping features on diagnostic testing. The water deprivation test, also known as the indirect water deprivation test should potentially be able to distinguish the various forms of DI. Deprivation of water intake should allow patients with primary polydipsia to concentrate their urine while those with central or nephrogenic DI continue to excrete dilute urine. Administration of desmopressin (Deamino-8-D-arginine vasopressin), the synthetic analogue of AVP, after water deprivation should help with differentiating patients with central DI from those with nephrogenic DI as the former should be able to concentrate the urine once the deficient action of AVP is replaced with desmopressin, while the latter should not show a significant response due to end-organ resistance to the action of AVP or its analogues.

• #24 Diabetes Insipidus (DI): Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/diabetes/what-is-diabetes-insipidus

  Your doctor will do a physical exam. A checkup may not show any signs of central diabetes insipidus DI, except maybe an enlarged bladder or symptoms of dehydration. […] Theyll ask questions about your health history, including your familys health. You might get a series of tests that include: […] Urinalysis. Youll give a sample of your pee, and your doctor will send it to a lab to see whether its dilute or concentrated. They can also check for glucose (sugar), which can help them decide if you have diabetes insipidus or diabetes mellitus. You might need to collect your pee over a 24-hour period to measure the volume you pass in a day. […] Blood test. There are a few different blood tests your doctor may order. These tests measure the electrolytes, glucose, and vasopressin levels in your blood. This lets your doctor know if you have diabetes mellitus or diabetes insipidus, and which type you have.

• #25 Get Diabetes Insipidus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/diabetes-insipidus-treatment

  Central diabetes insipidus: Happens when your body doesnt make or release enough antidiuretic hormone (ADH). […] Nephrogenic diabetes insipidus: Happens when your kidneys dont use ADH properly. […] Dipsogenic diabetes insipidus: Results from a problem with your hypothalamus. […] Gestational diabetes insipidus: Develops during pregnancy and goes away shortly after birth. […] What to expect at your first visit […] When you come to your first appointment, your provider will ask you to do something important share your story. Hearing this helps them get a better picture of whats been going on. […] To further pinpoint a diagnosis, your provider will also order tests to look for signs of diabetes insipidus or other conditions. […] Water deprivation test: This is the main test for diabetes insipidus. We restrict your liquid intake for up to 12 hours to see if you still have diluted urine.

• #26 Arginine vasopressin deficiency or resistance (Diabetes insipidus) – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/288

  Arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus) or resistance (AVP-R; previously known as nephrogenic diabetes insipidus) are disorders characterized by polydipsia, polyuria, and formation of inappropriately hypotonic (dilute) urine due to renal water loss. […] AVP-D occurs due to reduced synthesis or release of AVP from the hypothalamo-pituitary axis. AVP-R occurs due to renal insensitivity to AVP. […] Treatment goals are correction and stabilization of water deficit and electrolyte balance, together with reduction in symptoms of excessive urinary water loss and thirst. […] In AVP-D, the synthetic AVP analog desmopressin (also known as DDAVP) is the treatment of choice. AVP-R is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria.

• #27

  https://www.vin.com/apputil/content/defaultadv1.aspx?id=3846170&pid=11147

  The initial diagnostic tests for PU and PD include a CBC, serum biochemistry panel, urinalysis with bacterial culture, and a serum thyroxine concentration in older cats. Depending on the history and physical examination findings, abdominal ultrasonography may be warranted to evaluate the liver, kidneys, adrenal glands and uterus. Careful evaluation of the history, physical examination findings, and initial database usually provides the diagnosis outright or offers clues that allow the clinician to focus on the underlying cause. Occasionally, the physical examination and initial database appear normal in the dog or cat with PU and PD. Viable possibilities in these dogs and cats include DI, psychogenic water consumption, unusual hyperadrenocorticism, renal insufficiency without azotemia, and possibly mild hepatic insufficiency. If the urine specific gravity measured on multiple urine samples is consistently in the isosthenuric range (1.008 to 1.015), renal insufficiency should be considered the primary differential diagnosis, especially if the BUN and serum creatinine concentration are high normal or increased (i.e., $25 mg/dl and $1.8 mg/dl, respectively) and proteinuria is present. Although isosthenuria is relatively common in dogs with hyperadrenocorticism, psychogenic water consumption, hepatic insufficiency, pyelonephritis, and partial CDI with concurrent water restriction, urine specific gravities tend to fluctuate above (hyperadrenocorticism, psychogenic water consumption, hepatic insufficiency, pyelonephritis) and below (hyperadrenocorticism, psychogenic water consumption, partial CDI) the isosthenuric range in these disorders. If the urine specific gravity is consistently less than 1.006, renal insufficiency and pyelonephritis are ruled out and DI, psychogenic water consumption, and hyperadrenocorticism should be considered. Diagnostic tests to assess for hyperadrenocorticism (e.g., ACTH stimulation test), liver function (e.g., pre and postprandial bile acids), and renal insufficiency (urine p/c ratio, diagnostic imaging) should be considered before tests for DI.

• #28 Arginine vasopressin deficiency (central diabetes insipidus): Etiology, clinical manifestations, and postdiagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/arginine-vasopressin-deficiency-central-diabetes-insipidus-etiology-clinical-manifestations-and-postdiagnostic-evaluation

  Arginine vasopressin deficiency (AVP-D), previously called central diabetes insipidus, is characterized by decreased release of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), resulting in variable degrees of polyuria. […] The etiologies, clinical manifestations, and postdiagnostic evaluation of AVP-D are reviewed in this topic. […] Confirming the diagnosis – In normonatremic patients who have symptoms consistent with an arginine vasopressin disorder (eg, polyuria, nocturia, and polydipsia not resulting from uncontrolled diabetes mellitus or another obvious cause), the approach to confirming the diagnosis of AVP-D is as follows: Establish the presence of a water diuresis – Patients with confirmed polyuria (ie, urine output >40 to 50 mL/kg/day, typically assessed with a 24-hour urine collection) may have a solute diuresis or a water diuresis.

• #29 Arginine vasopressin deficiency (central diabetes insipidus): Etiology, clinical manifestations, and postdiagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-causes-of-central-diabetes-insipidus

  Arginine vasopressin deficiency (AVP-D), previously called central diabetes insipidus, is characterized by decreased release of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), resulting in variable degrees of polyuria. […] The etiologies, clinical manifestations, and postdiagnostic evaluation of AVP-D are reviewed in this topic. […] In normonatremic patients who have symptoms consistent with an arginine vasopressin disorder (eg, polyuria, nocturia, and polydipsia not resulting from uncontrolled diabetes mellitus or another obvious cause), the approach to confirming the diagnosis of AVP-D is as follows: Establish the presence of a water diuresis. […] Patients with polyuria and a water diuresis may have AVP-D, arginine vasopressin V2 resistance (AVP-R), or primary polydipsia. These three disorders can be distinguished using plasma copeptin (only if reliable assays are available), or with a water restriction test and assessing the response to desmopressin. […] Once the diagnosis of AVP-D has been confirmed, the next step is to determine its cause.

• #30 Arginine vasopressin deficiency (central diabetes insipidus): Etiology, clinical manifestations, and postdiagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/arginine-vasopressin-deficiency-central-diabetes-insipidus-etiology-clinical-manifestations-and-postdiagnostic-evaluation

  Establishing the presence of AVP-D – Patients with polyuria and a water diuresis may have AVP-D, arginine vasopressin V2 resistance (AVP-R), or primary polydipsia. […] Postdiagnostic evaluation to determine the etiology – Once the diagnosis of AVP-D has been confirmed, the next step is to determine its cause. […] In patients whose polyuria develops immediately after surgery in the sellar or suprasellar region, severe head trauma, or basilar skull fracture, AVP-D is typically transient.

• #31 Diabetes insipidus: Diagnosis and treatment of a complex disease | MDedge

  https://www.mdedge.com/content/diabetes-insipidus-diagnosis-and-treatment-complex-disease

  Diabetes insipidus, characterized by excretion of copious volumes of dilute urine, can be life-threatening if not properly diagnosed and managed. […] The distinction is essential for effective treatment.

• #32 Arginine Vasopressin Disorders (Diabetes Insipidus)

  https://my.clevelandclinic.org/health/diseases/16618-diabetes-insipidus

  Arginine vasopressin disorders formerly known as diabetes insipidus are two rare and treatable conditions in which your body lets go of too much pee. […] A diagnosis of AVP-D or AVP-R involves finding the type and cause. […] A water deprivation test is the most reliable way to diagnose either AVP-D or AVP-R. […] If you have AVP-D or AVP-R, its important to see your healthcare provider regularly. […] Cleveland Clinic offers diabetes insipidus treatment from experienced healthcare providers. Learn how we diagnose and manage this rare endocrine condition.

Zobacz więcej