Diabetes Insipidus

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DEFINITIONS

Diabetes insipidus is a discharge from the body in significant amounts due to two things:

Failure of vasopressin expenditure
Failure of the kidney to AVP stimulation

Diabetes insipidus is a rare disease, the disease is caused by a variety of causes which may disturb the mechanism neurohypophyseal – reflex renal failure resulting in mengkoversi water bodies.

CLINICAL SYMPTOMS

Complaints and the main symptoms of diabetes insipidus are polyuria and polydipsia. The amount of fluid intake and urine production per 24 hours so much, can reach 5 to 10 liters a day. Urine specific gravity is usually very low, ranging between 1001 – 1005, or 50 to 200 mOsmol / kg body weight. In addition to polyuria and polydipsia, usually there are no other symptoms unless there are other diseases that cause interference with the neurohypophyseal renal reflex mechanisms.

Pathogenesis

In the pathogenesis of diabetes insipidus above, have two names, diabetes insipidus centralist and diabetes insipidus nefrogenic.

Diabetes insipidus centralist (DIS) is caused by how many things belows:

Transport ADH / AVP that does not work properly due to damage to axons in the tract supraoptikohipofisealis
Synthesis of ADH disrupted
Damage to the supraoptic nucleus paraventricular
Failure of expenditure Vasopressin

Pathophysiology

Arginine Vasopressin is an antidiuretic hormone produced in the supraoptic nucleus, paraventricular, and filiformis hypothalamus, along with the restraints of neurofisin II. Vasopressin and then transported from the cell bodies of neurons where the making, through the axon toward the nerve endings in the posterior pituitary gland, which is a place of storage. Physiologically, vasopressin and inactive neurofisin be secreted when there is a certain stimuli. Vasopressin secretion is regulated by stimuli that increase in volume and osmotic receptors. An increase in extracellular fluid osmolality or a decrease in the volume intravaskuler will stimulate vasopressin secretion. Vasopressin and increased permeability of kidney collecting duct epithelium of the water through a mechanism involving activation of adenolisin and increase cyclic AMP. As a result, increased urinary concentration and decreased serum osmolality. Serum osmolality is usually kept constant by the narrow boundary between 290 and 296 mOsm / kg H2O.

Disruption of the physiology of vasopressin can cause the collection of water in renal collecting duct as decreases permeabilitasnya, which will cause polyuria or urinate a lot.

In addition, it increased the plasma osmolality stimulates thirst center, and conversely a decrease of plasma osmolality suppresses thirst center. Excitatory threshold osmotic thirst center is higher than the threshold of stimulation vasopressin secretion. Therefore, when plasma osmolality increases, the body will first deal with that when secreting vasopressin was increased to stimulate the thirst center, which will have implications for these people drink a lot (polydipsia).

In pathogenesis, diabetes insipidus 2 is divided into central diabetes insipidus, where vasopressin disorders in themselves and nefrogenik diabetes insipidus, where the interference is not responsive to vasopressin renal tubules.

Diabetes insipidus central can be caused by the failure of ADH release of antidiuretic hormone, which is the failure of synthesis or storage. This can be caused by damage to the supraoptic nucleus, paraventricular, and mensistesis hypothalamic filiformis ADH. In addition, DIS also arise due to disruption of transportation of ADH due to damage in the axon tract supraoptikohipofisealis and posterior pituitary aksin where ADH is stored for any time released into the circulation if needed.

DIS can also occur due to the absence of ADH synthesis, or synthesis of ADH is not sufficient for quantitative, or quantitative, but not enough to function normally. Finally, it was found that the DIS can also occur due to the formation of antibodies against ADH.

Aetiology

There are some circumstances that lead to central diabetes insipidus, includes tumors in the hypothalamus, tumors of the pituitary and destroy the nucleus-nucleus hipotalamik, head trauma, surgery on the hypothalamic injury, occlusion of intracerebral blood vessels, and diseases granuomatosa .

Clinical symptoms

Complaints and the main symptoms of diabetes insipidus are polyuria and polydipsia. The amount of urine production and fluid intake per 24 hours very much. In addition to polyuria and polydipsia, usually there are no other symptoms, except the new dangers that arise due to dehydration and increased concentration of dissolved materials arising from the disruption stimulates thirst.

Diabetes Nefrogenik (DIN) is diabetes insipidus is not responsive to exogenous ADH

Aetiology

Diabetes insipidus Nefrogenik can be caused by several things that are:

chronic kidney disease, polycystic kidney disease, Medullary cystic disease, Pielonefretis, ureteral obstruction, advanced renal failure
Electrolytes obstruction, Hypokalaemia, Hypercalcaemia
Drugs 3, lithium, demoksiklin, asetoheksamid, tolazamid, glikurid, propoksifen
sickle cell disease
interference diet

Diagnosis

There is a way to diagnose the cause of polyuria is due to diabetes insipidus, not because of other diseases. The trick is to answer three questions that we can know with anamnesa and examination.

First, what causes polyuria that is income such material (in this case water) to the kidney excessive or excessive expenditure. If the anamnesa found that the patient was drinking a lot, so naturally when it happens polyuria.

Second, whether the cause of this polyuria was renal factor or not. Polyuria can occur in acute renal disease in diuresis when the healing period. However, if this polyuria occurs because of acute renal disease, then there will be a history oligouria (little urine).

Third, Is the main ingredients that make up the urine in polyuria is water without or with substances that are dissolved. In general, polyuria due to diabetes insipidus pure water out, but did not rule in the dissolved materials. If found dissolved materials in the form of high glucose levels (abnormal) it can be suspected that the polyuria was due to the DM who is one of the Differential Diagnosis of diabetes insipidus.

Examination Support

If we suspect this is the cause of polyuria Insipidua diabetes, it must conduct to support the diagnosis and to distinguish whether the type of diabetes insipidus is experienced, because the management of the two types of diabetes insipidus was different. There are few checks on diabetes insipidus, they are:

Hickey Hare or the Carter-Robbins
Fluid deprivation
Test Nicotine

Regardless of the examination, the principle is to know the volume, density, or concentration of urine. While to know the type, can provide synthetic vasopressin, central diabetes insipidus in will decrease the amount of urine, and in diabetes insipidus Nefrogenik not happen.