scholarly journals The water deprivation test and a potential role for the arginine vasopressin precursor copeptin to differentiate diabetes insipidus from primary polydipsia

2015 ◽  
Vol 4 (2) ◽  
pp. 86-91 ◽  
Author(s):  
M de Fost ◽  
S M Oussaada ◽  
E Endert ◽  
G E Linthorst ◽  
M J Serlie ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Arginine Vasopressin ◽  
Clinical Judgment ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Water Deprivation ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Water Deprivation Test ◽  
Primary Polydipsia

The water deprivation test is the gold standard test to differentiate central or nephrogenic diabetes insipidus (DI) from primary polydipsia (PP) in patients with polyuria and polydipsia. Few studies have addressed the diagnostic performance of this test. The aim of this retrospective cohort study was to evaluate the diagnostic performance of the standard water deprivation test, including plasma arginine vasopressin (AVP) measurements, in 40 consecutive patients with polyuria. We compared initial test results with the final clinical diagnosis, i.e., no DI, central DI, or nephrogenic DI. The median length of follow-up was 8 years. In a subset of ten patients, the novel marker copeptin (CP) was measured in plasma. Using the final diagnosis as a gold standard, a threshold for urine osmolality of >800 mOsmol/kg after water deprivation yielded a sensitivity and specificity of 96 and 100%, respectively, for diagnosing PP. Sensitivity increased to 100% if the cut-off value for urine osmolality was set at 680 mOsmol/kg. Plasma AVP levels did not differ between patient groups and did not differentiate among central DI, nephrogenic DI, or PP. In all three patients with central DI, plasma CP was <2.5 pmol/l with plasma osmolality >290 mOsmol/kg, and >2.5 pmol/l in patients without DI. The optimal cut-off value for differentiating PP from DI during a water deprivation test was urine osmolality >680 mOsmol/kg. Differentiating between central and nephrogenic DI should be based on clinical judgment as AVP levels did not discriminate.

Disorders of the posterior pituitary gland

2010 ◽  
pp. 1819-1825
Author(s):  
Aparna Pal ◽  
Niki Karavitaki ◽  
John A. H. Wass
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Arginine Vasopressin ◽  
Water Deprivation ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Posterior Pituitary ◽  
Posterior Pituitary Gland ◽  
Long Acting ◽  
Cranial Diabetes Insipidus

The posterior pituitary produces arginine vasopressin, which has a key role in fluid homeostasis, and oxytocin, which stimulates uterine contraction during birth and ejection of milk during lactation. Cranial diabetes insipidus is the passage of large volumes (>3 litres/24 h) of dilute urine (osmolality<300 mOsm/kg) due to vasopressin deficiency, and most commonly occurs as a consequence of trauma or tumour affecting the posterior pituitary. Diagnosed by a water deprivation test revealing urine osmolality less than 300 mOsml/kg with concurrent plasma osmolality more than 290 mOsml/kg after dehydration, with urine osmolality rising to more than 750 mOsml/kg after desmopressin. MRI of the neurohypophysis is required to delineate the cause. Mild polyuria can be managed simply by ensuring adequate fluid intake; treatment with the long-acting vasopressin analogue, desmopressin (desamino, D-8 arginine vasopressin; DDAVP), is used for more severe cases....

Impairment of osmotically stimulated AVP release in patients with primary polydipsia

1993 ◽  
Vol 265 (6) ◽  
pp. R1247-R1252 ◽  
Author(s):  
A. M. Moses ◽  
B. Clayton
Keyword(s):  
Diabetes Insipidus ◽  
Arginine Vasopressin ◽  
Plasma Osmolality ◽  
Normal Subjects ◽  
Urine Concentration ◽  
Published Data ◽  
Posterior Pituitary ◽  
Primary Polydipsia ◽  
Number Of Factors

The secretion of arginine vasopressin (AVP) from the posterior pituitary is primarily and finely regulated by the osmolality of plasma. Even though a number of factors alter osmolality-induced release of AVP, there are no published data in humans that have addressed the role of chronic overhydration on this phenomenon. To address this problem we have identified eight patients with primary polydipsia using criteria not involving measurement of AVP, and have subjected them to standardized infusions of hypertonic saline. These patients had less AVP in both plasma and urine in relation to plasma osmolality than was found in normal subjects. In addition, their rate of rise of plasma and urine AVP was less than in normal subjects. Their osmotic threshold for AVP release may have been higher than normal. These data demonstrate that chronic overhydration in humans downregulates the release of AVP in response to hypertonicity. This phenomenon may explain the impairment of urine concentration in patients with primary polydipsia and emphasizes the basis of the difficulty that may occur clinically in differentiating between patients with primary polydipsia and partial central diabetes insipidus.

The occurrence of nephrogenic diabetes insipidus in domestic fowl

1989 ◽  
Vol 256 (4) ◽  
pp. F639-F645 ◽  
Author(s):  
E. J. Braun ◽  
J. N. Stallone
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Domestic Fowl ◽  
Nephrogenic Diabetes Insipidus ◽  
Water Deprivation ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Arginine Vasotocin ◽  
Basal Plasma ◽  
Response To Water

Nephrogenic diabetes insipidus (NDI) results from an inability of the kidney to concentrate the urine. The underlying cause of NDI is the failure of the collecting ducts to respond to antidiuretic hormone, however, the specific tubular defect is not well understood. In the present investigation an apparent case of NDI was studied in a strain of White Leghorn domestic fowl. In this strain, water intake of the males equaled 24.0% (controls 5.4%) of their body mass (BM) per day while that of the females equaled 51.4% (controls 11.7%) of their BM per day. Plasma osmolality (mosmol/kgH2O) of the NDI birds was significantly higher than that of controls (males 319 +/- 1.7 vs. 311 +/- 1.2; females 323 +/- 1.5 vs. 310 +/- 2.2). Urine osmolality of NDI birds was substantially lower than that of controls (males 90 +/- 6.2 vs. 524 +/- 4.0; females 70 +/- 4.7 vs. no value). In response to water deprivation, plasma osmolality of the NDI birds increased more markedly than that of the control animals (males 357 +/- 2.5 vs. 331 +/- 1.2; females 375 +/- 6.0 vs. 348 +/- 1.4 at 48 h of water deprivation). Basal plasma antidiuretic hormone (plasma arginine vasotocin, PAVT) levels in male NDI birds (9.9 +/- 0.7 microU/ml) and in female NDI birds (7.0 +/- 0.5 microU/ml) were nearly sixfold or nearly threefold higher, respectively, than in control birds. In response to water deprivation, PAVT of both NDI and control birds increased to similar levels, although the absolute increases in PAVT levels were substantially less in NDI birds.(ABSTRACT TRUNCATED AT 250 WORDS)

THE USE OF CHLORPROPAMIDE IN DIABETES INSIPIDUS IN CHILDREN

PEDIATRICS ◽  
1970 ◽  
Vol 45 (2) ◽  
pp. 236-245
Author(s):  
Robert M. Ehrlich ◽  
Sang Whay Kooh
Keyword(s):  
Diabetes Insipidus ◽  
Water Deprivation ◽  
Plasma Insulin ◽  
Urine Volume ◽  
Insulin Response ◽  
Urine Osmolality ◽  
Post Traumatic ◽  
Term Management ◽  
Plasma Insulin Response

Oral chlorpropamide was administered to 17 children with diabetes insipidus (D.I.). The cause of the D.I. was idiopathic, six; histiocytosis, five; craniopharyngioma, three; pinealoma, two, and post-traumatic, one. Twenty-four-hour urine volume and measurements of serum and urine osmolality at the beginning and end of a 7-hour water deprivation test were used to evaluatechlorpropamide therapy. Administration of 150 to 400 mg of chlorpropamide per day by mouth caused a reduction in urine volume in all patients (range 8 to 67%). No change in aldosterone, 17-hydroxycorticoids, or electrolyte excretion was noted. Serum electrolytes and glomerular filtration rate were not affected by therapy. Glucose tolerance and plasma insulin response remained normal in those patients tested. Mild leucine sensitivity without significant change in plasma insulin was induced in four children. During water deprivation, seven patients with secondary D.I. but only one with idiopathic D.I. produced hypertonic urine. Hypoglycemia developed in seven children and is the major hazard of treatment. Long-term management of D.I. has been possible in nine children. Oral chlorpropamide is a useful drug in children with vasopressin-sensitive diabetes insipidus.

scholarly journals Urine specific gravity as a diagnostic tool for dehydration in children

2010 ◽  
Vol 50 (5) ◽  
pp. 269 ◽  
Author(s):  
Kalis Joko Purwanto ◽  
Mohammad Juffrie ◽  
Djauhar Ismail
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Specific Gravity ◽  
Diagnostic Tool ◽  
Clinical Judgment ◽  
Plasma Osmolality ◽  
Body Weight Loss ◽  
Urine Osmolality ◽  
Urine Specific Gravity ◽  
Urine Production

Background Using clinical judgment to diagnose dehydration can be highly subjective. To diagnose dehydration, it would be ideal to have an accurate, inexpensive, objective and easy-to-perform diagnostic tool. In cases of dehydration, plasma osmolality rises, causing an increase in antidiuretic hormone (ADH) secretion. The increased ADH reduces urine production and increases urine osmolality. Previous studies have show that urine osmolality correlates well to urine specific gravity. We investigated if urine specific gravity can be a reliable and objective detennination of dehydration status.Objective To assess the accuracy of using urine specific gravity as a diagnostic tool to determine dehydration status of children with diarrhea.Methods We conducted the study in the pediatric ward of Sardjito Hospital from September 2009 to December 2009. Using a refractometer we measured urine specific gravity from patients with diarrhea. This measurement was then compared to a standard of acute body weight loss, with dehydration defined as weight loss of 5% or more. The cut-off value for defining dehydration using specific gravity measurements was detennined by a receiver-operator curve (ROC).Results Out of 61 pediatric patients who were recruited in this study, 18 (30%) had dehydration as defined by a body weight loss of 5% or more. Based on the ROC, we determined the cut off  value for urine specific gravity to be 1.022. Using this value, urine specific gravity was 72% sensitive (95% CI 52 to 93), and 84% specific (95% CI 73 to 95) in determining dehydration status.Conclusion Urine specific gravity is less accurate than clinical judgment in determining dehydration status in children with diarrhea.

Polyuria

2020 ◽  
Keyword(s):  
Diabetes Insipidus ◽  
Water Deprivation ◽  
Water Deprivation Test ◽  
Key Points

Key Points Polyuria can result from too much fluid, too much solute, or too little arginine vasopressin.When diabetes insipidus (DI) is diagnosed, its cause must be determined.With central DI, other pituitary functions must be evaluated.A water deprivation test is the criterion standard for distinguishing among central DI, nephrogenic DI, and polydipsia.

Sex difference in urinary concentrating ability of rats with water deprivation

1996 ◽  
Vol 270 (3) ◽  
pp. R550-R555 ◽  
Author(s):  
Y. X. Wang ◽  
J. T. Crofton ◽  
J. Miller ◽  
C. J. Sigman ◽  
H. Liu ◽  
...  
Keyword(s):  
Water Deprivation ◽  
Plasma Concentrations ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Ovarian Hormones ◽  
Urine Flow ◽  
The Other ◽  
Consumptive Behavior ◽  
Urinary Concentrating Ability ◽  
Previous Demonstration

Our previous demonstration of sexual dimorphism in the antidiuretic response to exogenous vasopressin prompted us to investigate the response to moderately high levels of endogenous vasopressin stimulated by water deprivation in conscious rats. After 24 h water deprivation, urine flow was significantly higher and urine osmolality lower in females than in males. Plasma concentrations of vasopressin were higher in females than in males after water deprivation, but plasma osmolality did not differ. Gonadectomy, which had no effect in dehydrated males, decreased urine flow and increased urine osmolality in females to levels observed in intact and gonadectomized males. Spontaneous water intake was also measured and found to be lower in males and estrous females than in females in the other phases of the estrous cycle. These observations support the concept that there is a gender difference in the antidiuretic responsiveness to endogenous vasopressin, that this difference is dependent upon the ovarian hormones, and that it may lead to differences in consumptive behavior.

Maternal dehydration-rehydration: fetal plasma and urinary responses

1988 ◽  
Vol 255 (5) ◽  
pp. E674-E679 ◽  
Author(s):  
M. G. Ross ◽  
D. J. Sherman ◽  
M. G. Ervin ◽  
R. Castro ◽  
J. Humme
Keyword(s):  
Glomerular Filtration Rate ◽  
Arginine Vasopressin ◽  
Filtration Rate ◽  
Urine Volume ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Fetal Plasma ◽  
Urine Production ◽  
The Impact ◽  
Observation Period

Pregnant women may be exposed to exercise, thermal, or gastrointestinal (hyperemesis) water loss, all of which commonly induce a greater than 10 mosmol increase in plasma osmolality. Although fetal osmolality is dependent on maternal osmolality, the impact of maternal dehydration and subsequent maternal rehydration on the fetus has not been explored. Five pregnant ewes with singleton fetuses (136 +/- 1 day) were water deprived for 36 h resulting in a significant increase in plasma osmolality (298 +/- 3.4 to 313 +/- 5.0 mosmol). In response to maternal dehydration, fetal plasma osmolality (297.0 +/- 4.1 to 309.3 +/- 4.1 mosmol), arginine vasopressin (AVP) levels (1.5 +/- 0.2 to 7.9 +/- 1.0 pg/ml), hematocrit (35.1 to 38.6%), and urine osmolality (161.3 +/- 10.7 to 348.9 +/- 21.9 mosmol) significantly increased. Subsequently, ewes were rehydrated over 4 h with intravenously infused 0.45% saline (20 ml.kg-1.h-1). In response to maternal rehydration, maternal and fetal plasma osmolality decreased to basal values (298.9 +/- 3.2 and 300.1 +/- 3.8 mosmol, respectively) and fetal glomerular filtration rate (1.72 +/- 0.30 to 3.08 +/- 0.66 ml/min) and urine volume significantly increased (0.33 +/- 0.02 to 0.71 +/- 0.13 ml/min). However, fetal hematocrit (37.4%), plasma AVP (3.1 +/- 0.9 pg/ml), and urine osmolality (255.4 +/- 28.8 mosmol) did not return to basal levels during the observation period. These results demonstrate fetal hyperosmolality, blood volume contraction, AVP secretion, and altered urine production in response to maternal dehydration. Despite maternal rehydration and normalization of maternal and fetal plasma osmolality, fetal endocrine and fluid responses are prolonged.(ABSTRACT TRUNCATED AT 250 WORDS)

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