Treatment for nephrogenic diabetes insipidus? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 01-05-2010
USMLE Forums Veteran
 
Steps History: ---
Posts: 238
Threads: 56
Thanked 203 Times in 61 Posts
Reputation: 233
Kidney Treatment for nephrogenic diabetes insipidus?

3 are listed in First Aid : Thiazide, indomethacin, amiloride.

If I am not mistaken, amiloride is special for lithium causes of nephogenic diabetes insipidus.

But what I am wondering is, if the diabetes insipidus is secondary to hypercalcemia, would you think that giving thiazide is not really a good idea? Hence, if facing a question asking for the treatment of nephrogenic diabetes insipidus which is due to nephrocalcinosis, should we answer the listed treatment by First Aid (thiazide, indomethacin, amiloride) or would Furosemide be a better answer?

What do you guys thinK?
Reply With Quote Quick reply to this message
The above post was thanked by:
aungawa (04-07-2010), drali (12-22-2010), hana (01-20-2011), Taiwan_Guy (07-26-2011)



  #2  
Old 01-05-2010
3abass's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 25
Threads: 4
Thanked 22 Times in 12 Posts
Reputation: 32
Default

Who told you that drug induced nephrogenic DI is due to hypercalcemia!
Reply With Quote Quick reply to this message
  #3  
Old 01-05-2010
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 32
Threads: 13
Thanked 253 Times in 24 Posts
Reputation: 283
Default

The paradoxical effect of thiazide in the treatment of nephrogenic diabetes insipidus is not fully understood and has been puzzling scientists.
One proposed theory is that when you give thiazide (it works on the distal tubule) you'll initially increase sodium excretion which then leads to contraction of the ECF which then leads to increased proximal convoluted tubules reabsorption of Sodium and water and thereby ameliorating the diuresis.

Therefore, any diuretic that is going to work in NDI must be working at the distal parts of the nephron such as thiazides or amiloride (and furosemide may not be a good choice).

The only example of drug induced NDI that is ever going to be seen in your clinical practice (hence your USMLE exam) is the Lithium induced.

Lithium is a cation just like Sodium and giving it for prolonged periods will be just like giving Sodium to the patient and therefore you end up with polyuria and diuresis. How that is resistant to the action of ADH is yet to be determined but the message is that, use the most distal diuretic (e.g amiloride) to treat the specific Lithium induced DI.
Reply With Quote Quick reply to this message
The above post was thanked by:
Akram_Alsalman (11-06-2016), Arhtur liu (11-13-2014), aungawa (04-07-2010), dr-ahmed (11-18-2013), drdhruv (03-19-2013), egyptiandoc (01-21-2014), Krazy (12-14-2013), lemontea88 (01-05-2010), Obaidwardak (09-03-2016), OmarRabiee (01-30-2016), rafa_decosta (05-23-2013), rigbbm (02-11-2016), Romaniv (05-23-2016), scientist66 (04-09-2015), smile135 (01-05-2010), studyhard (07-27-2010), tarsuc (01-18-2013), Thrax_usmle (03-18-2013), tomymajor (01-09-2010), Yassamine (11-13-2013)
 
  #4  
Old 01-05-2010
USMLE Forums Veteran
 
Steps History: ---
Posts: 238
Threads: 56
Thanked 203 Times in 61 Posts
Reputation: 233
Default

Quote:
Originally Posted by 3abass View Post
Who told you that drug induced nephrogenic DI is due to hypercalcemia!
Oh sorry I think maybe my post above wasn't written clearly.

What I meant to say was, we know that examples of drug induced NDI are like lithium and demeclocycline, and their treatment are like thiazides and amiloride.

My question was, how bout if the NDI is due to hyperparathyroidism, leading to increased in serum calcium, and the high calcium levels cause our collecting tubule basement membrane to calcify, leading to a "Hypercalcemic-cause of NDI". In this scenario, are we still gonna use thiazides (which will lead to further increase in calcium levels since it decreases calcium excretion) as a treatment?
Reply With Quote Quick reply to this message
The above post was thanked by:
aungawa (04-07-2010), marya esh (03-11-2017)
  #5  
Old 01-05-2010
USMLE Forums Veteran
 
Steps History: ---
Posts: 238
Threads: 56
Thanked 203 Times in 61 Posts
Reputation: 233
Default

Quote:
Originally Posted by Ahmed-USMLE View Post
The paradoxical effect of thiazide in the treatment of nephrogenic diabetes insipidus is not fully understood and has been puzzling scientists.
One proposed theory is that when you give thiazide (it works on the distal tubule) you'll initially increase sodium excretion which then leads to contraction of the ECF which then leads to increased proximal convoluted tubules reabsorption of Sodium and water and thereby ameliorating the diuresis.

Therefore, any diuretic that is going to work in NDI must be working at the distal parts of the nephron such as thiazides or amiloride (and furosemide may not be a good choice).

The only example of drug induced NDI that is ever going to be seen in your clinical practice (hence your USMLE exam) is the Lithium induced.

Lithium is a cation just like Sodium and giving it for prolonged periods will be just like giving Sodium to the patient and therefore you end up with polyuria and diuresis. How that is resistant to the action of ADH is yet to be determined but the message is that, use the most distal diuretic (e.g amiloride) to treat the specific Lithium induced DI.
Hmm, I see, glad to know that the Boards are still fairly reasonable.
Reply With Quote Quick reply to this message
The above post was thanked by:
tomymajor (01-05-2010)
  #6  
Old 01-05-2010
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 32
Threads: 13
Thanked 253 Times in 24 Posts
Reputation: 283
Default

Quote:
Originally Posted by lemontea88 View Post
Oh sorry I think maybe my post above wasn't written clearly.

What I meant to say was, we know that examples of drug induced NDI are like lithium and demeclocycline, and their treatment are like thiazides and amiloride.

My question was, how bout if the NDI is due to hyperparathyroidism, leading to increased in serum calcium, and the high calcium levels cause our collecting tubule basement membrane to calcify, leading to a "Hypercalcemic-cause of NDI". In this scenario, are we still gonna use thiazides (which will lead to further increase in calcium levels since it decreases calcium excretion) as a treatment?
Hypercalcemia induced NDI is caused by increased calcium excretion in urine. Thiazides decrease Calcium excretion in urine so they are going to be useful.
Reply With Quote Quick reply to this message
The above post was thanked by:
Akram_Alsalman (11-06-2016), faisalahmed518 (01-25-2015), Krazy (12-14-2013), lemontea88 (01-05-2010), marya esh (03-11-2017), MrAnatomy (03-27-2013), runawaycorpus (04-07-2010), studyhard (07-27-2010), tahir (01-01-2011), tomymajor (01-05-2010)
  #7  
Old 01-05-2010
USMLE Forums Veteran
 
Steps History: ---
Posts: 238
Threads: 56
Thanked 203 Times in 61 Posts
Reputation: 233
Default

Ahh, that makes sense. Thanks.
Reply With Quote Quick reply to this message
  #8  
Old 01-05-2010
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 3
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Thumbs Up

This is a great discussion guys
Reply With Quote Quick reply to this message
  #9  
Old 04-07-2010
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

This is a great discussion, I was previously quite confused with " nephrogenic DI secondary to hypercalcemia" and the use of thiazide as one of the treatment for acquired NDI from the First Aid.

I really think the usage of "hypercalcemia" from the first aid is so misleading.
Reply With Quote Quick reply to this message



Reply

Tags
Endocrine-, Pharmacology-, Renal-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Why is HCTZ is a choice of treatment for Nephrogenic DI? buttercupmd USMLE Step 1 Forum 8 06-09-2011 06:21 PM
question_ central diabetes insipidus mtoi USMLE Step 1 Forum 4 11-16-2010 02:54 AM
question_ central diabetes insipidus mtoi USMLE Step 1 Forum 2 11-04-2010 09:22 AM
K & Ca in Nephrogenic DI good_boy_1234 USMLE Step 2 CK Forum 16 09-04-2010 07:25 PM
Diabetes Insipidus Diagnosis jackat1000 USMLE Step 1 Mnemonics 0 07-25-2010 09:57 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)