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Khosravi M, Walsh SB. The long-term complications of the inherited tubulopathies: an adult perspective. Pediatr Nephrol 2015; 30:385-95. [PMID: 24566812 DOI: 10.1007/s00467-014-2779-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022]
Abstract
The inherited tubulopathies are lifelong disorders and their clinical features and complications may present quite different challenges in adulthood from those in childhood. In this review we outline the pathophysiology and documented complications (including the late and unusual) of the monogenic tubulopathies from the perspective of the adult nephrologist.
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Affiliation(s)
- Maryam Khosravi
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
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Al-Kandari SR, Pandey T, Badawi MH. Intracranial calcification in central diabetes insipidus. Pediatr Radiol 2008; 38:101-3. [PMID: 17955235 DOI: 10.1007/s00247-007-0608-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 07/21/2007] [Accepted: 07/23/2007] [Indexed: 11/28/2022]
Abstract
Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification.
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Affiliation(s)
- Salwa Ramadan Al-Kandari
- Department of Clinical Radiology, Al Razi Hospital, Gamal Abdel Nasser Street, Kuwait 4234, Kuwait
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Schulz A, Römpler H, Mitschke D, Thor D, Schliebe N, Hermsdorf T, Strotmann R, Sangkuhl K, Schöneberg T. Molecular basis and clinical features of nephrogenic diabetes insipidus. Expert Rev Endocrinol Metab 2006; 1:727-741. [PMID: 30754158 DOI: 10.1586/17446651.1.6.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Maintenance of water and electrolyte homeostasis is central to mammalian survival and, therefore, under stringent hormonal control. Water homeostasis is achieved by balancing fluid intake with water excretion, governed by the antidiuretic action of arginine vasopressin. Arginine vasopressin stimulation of renal V2 vasopressin receptors in the basolateral membrane of principal cells induces aquaporin-2-mediated water reabsorption in the kidney. The importance of this system is apparent when mutations inactivate V2 vasopressin receptors and aquaporin-2 and cause the clinical phenotype of nephrogenic diabetes insipidus. To date, over 190 mutations in the V2 vasopressin receptors gene (AVPR2) and approximately 38 mutations in the aquaporin-2 gene have been identified in patients with inherited nephrogenic diabetes insipidus. Extensive in vitro expression and mutagenesis studies of V2 vasopressin receptors and aquaporin-2 have provided detailed insights into the molecular mechanisms of G-protein-coupled receptor and water channel dysfunction per se. Targeted deletions of AVPR2 and AQP2 in mice have extended the knowledge of nephrogenic diabetes insipidus pathophysiology and have stimulated testing of old and new ideas to therapeutically restore normal kidney function in animal models and patients with this disease. In this review, we summarize the current knowledge relevant to understand the molecular basis of inherited nephrogenic diabetes insipidus forms and the rationales for the current pharmacological treatment of patients with this illness.
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Affiliation(s)
- Angela Schulz
- a University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Holger Römpler
- b University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Doreen Mitschke
- c University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Doreen Thor
- d University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Nicole Schliebe
- e University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Thomas Hermsdorf
- f University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Rainer Strotmann
- g University of Leipzig, Institute of Biochemistry, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103, Leipzig, Germany.
| | - Katrin Sangkuhl
- h Division of Reproductive Biology, Department of Obstetrics and Gynecology, Stanford University Medical Center, California, USA.
| | - Torsten Schöneberg
- i University of Leipzig, Molecular Biochemistry, Medical Faculty, Johannisallee 30, 04103 Leipzig, Germany.
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Bajpai A, Kabra M, Thapliyal R, Gulati S, Kalra V. Nephrogenic diabetes insipidus presenting with developmental delay and intracranial calcification. Indian J Pediatr 2005; 72:527-8. [PMID: 15985744 DOI: 10.1007/bf02724433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A one-year-boy presented with constipation, fever, failure to thrive and developmental delay from the neonatal period. Investigations revealed persistent hypernatremia and deranged renal functions. Diagnostic work-up was suggestive of nephrogenic diabetes insipidus (NDI). Computerized tomography of head revealed calcification in the frontal, thalamic and basal ganglia region. The rare association of NDI and intracranial calcification is discussed.
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Affiliation(s)
- Anurag Bajpai
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Kirchlechner V, Koller DY, Seidl R, Waldhauser F. Treatment of nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride. Arch Dis Child 1999; 80:548-52. [PMID: 10332005 PMCID: PMC1717946 DOI: 10.1136/adc.80.6.548] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nephrogenic diabetes insipidus (NDI) is characterised by the inability of the kidney to concentrate urine in response to arginine vasopressin. The consequences are severe polyuria and polydipsia, often associated with hypertonic dehydration. Intracerebral calcification, seizures, psychosomatic retardation, hydronephrosis, and hydroureters are its sequelae. In this study, four children with NDI were treated with 3 mg/kg/day hydrochlorothiazide and 0.3 mg/kg/day amiloride orally three times a day for up to five years. While undergoing treatment, none of the patients had signs of dehydration or electrolyte imbalance, all showed normal body growth, and there was no evidence of cerebral calcification or seizures. All but one had normal psychomotor development and normal sonography of the urinary tract. However, normal fluid balance was not attainable (fluid intake, 3.8-7.7 l/m2/day; urine output, 2.2-7.4 l/m2/day). The treatment was well tolerated and no side effects could be detected. Prolonged treatment with hydrochlorothiazide/amiloride appears to be more effective and better tolerated than just hydrochlorothiazide. Its efficacy appears to be similar to that of hydrochlorothiazide/indomethacin but without their severe side effects.
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Affiliation(s)
- V Kirchlechner
- Department of Pediatrics, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Hoekstra JA, van Lieburg AF, Monnens LA, Hulstijn-Dirkmaat GM, Knoers VV. Cognitive and psychosocial functioning of patients with congenital nephrogenic diabetes insipidus. AMERICAN JOURNAL OF MEDICAL GENETICS 1996; 61:81-8. [PMID: 8741926 DOI: 10.1002/(sici)1096-8628(19960102)61:1<81::aid-ajmg17>3.0.co;2-s] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mental retardation (MR) is generally considered one of the main complications of congenital nephrogenic diabetes insipidus (NDI). However, psychometric studies of NDI patients are scarce and outdated. In the present study, 17 male NDI patients underwent psychological evaluation. Total intelligence quotient of 14 patients was within (n = 13) or above (n = 1) the normal range, 1 patient had an intelligence score between -1 and -2 standard deviations (S.D.) and 2 young patients had a general cognitive index more than 2 S.D. below the norm. Attention deficit hyperactivity disorder criteria were met by 8 out of 17 patients and scores on short-term memory were low in 7 out of 10. No relation between test performances and age at diagnosis or hypernatremia could be found, with the exception of a negative correlation between age at start of therapy and verbal IQ in one age group. Although several explanations for an association between MR and NDI can be postulated, it seems that the current prevalence of MR among patients with this disease is considerably lower than suggested in literature.
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Affiliation(s)
- J A Hoekstra
- Department of Medical Psychology, University Hospital Nijmegen, Netherlands
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