Treatment of Congenital Nephrogenic Diabetes insipidus with Hydrochlorothiazide and Amiloride in an Adult Patient

Abstract

Aim: The effects of treatment with hydrochlorothiazide (HCTZ) combined with amiloride were elucidated and compared to HCTZ treatment alone and combined with acemetacin or triamterene in a Japanese adult patient with congenital nephrogenic diabetes insipidus. Methods: The study was divided into seven periods: (1) HCTZ and acemetacin; (2) control period; (3) HCTZ; (4) a second control period; (5) HCTZ and amiloride; (6) a third control period, and (7) HCTZ and triamterene. Fluid intake, urine volume, urinary Na, K, creatinine, and osmolality and serum Na, K, Cl, CO₂, and osmolality were measured, and free water clearance and proximal and distal tubular Na reabsorption rates were calculated. Results: Without drug administration, the urine volume was about 8,000 ml/day. The urine volume was reduced to about 6,000 ml/day with HCTZ. A further urine volume reduction to about 5,000 ml/day was obtained with the second drug administration, and the effects were similar among the three regimens. Serum and urinary osmolality and free water clearance were also similar among the three combinations, whereas the urinary potassium excretion was the least, and the serum potassium concentration was the highest with HCTZ plus amiloride. Besides, no alkalosis was observed only with this combination. Conclusion: HCTZ plus amiloride may be superior to HCTZ plus acemetacin and HCTZ plus triamterene in preventing hyperkaliuria, hypokalemia, and metabolic alkalosis.

Nrf2 activation protects against lithium-induced nephrogenic diabetes insipidus

“…Thiazide diuretics exhibit a paradoxical antidiuretic effect when administered to experimental animals or patients with NDI (41)(42)(43)(44)(45). Similar to our observations in Li-treated Keap1 hm (Figure 3), thiazide-induced reduction in polyuria occurs without proportionate rescue of urine osmolality (43)(44)(45).…”

Diabetes Insipidus: Celebrating a Century of Vasopressin Therapy

“…Second, discontinue any drugs that may be causing acquired forms of NDI. The first line drug combination for adults with congenital NDI is hydrochlorothiazide (2-4 mg/kg per 24 h) and amiloride (0.3 mg/kg per 24 h) (154). Children are typically prescribed hydrochlorothiazide and indomethacin (2 mg/kg per 24 h), because amiloride can cause persistent nausea (121).…”

Cell biological aspects of the vasopressin type-2 receptor and aquaporin 2 water channel in nephrogenic diabetes insipidus

“…CELL BIOLOGICAL ASPECTS OF V2R AND AQP2 IN NDI volume in NDI, which is, at least for hydrochlorothiazide, more pronounced in combination with a low-salt diet (36,71). The combined administration of hydrochlorothiazide with either a prostaglandin synthesis [or cyclooxygenase (COX)] inhibitor such as indomethacin (2 mg⅐kg Ϫ1 ⅐day Ϫ1 ) or the potassium-sparing diuretic amiloride was shown to be much more effective in reducing urine volume than the thiazidediuretic alone (4,58,73,74,97,127). Long-term use of prostaglandin-synthesis inhibitors, however, is often complicated by gastrointestinal and hematopoietic side effects.…”