definition of diabetes insipidus

Rejekine. Diabetes insipidus is the process of discharge from the body in significant amounts due to two causes, namely :

Failure of vasopressin expenditure
Failure of the kidney to stimulation of AVP

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

CLINICAL SYMPTOMS

Complaints and the main symptoms of diabetes insipidus are polyuria and polydipsia. The amount of fluid you drink or the production of urine per 24 hours is very much, can reach 50-10 liters a day. Specific gravity of urine is usually very low, ranging between 1001 - 1005 or 50-200 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 mechanism.


Pathogenesis
In the pathogenesis of diabetes insipidus in the above two, namely :

1. central diabetes insipidus and nephrogenic diabetes insipidus.
2. Central diabetes insipidus (DIS)
3. DIS is caused by how things are:
4. transport of ADH / AVP that is not working properly due to damage to axons in the tract supraoptikohipofisealis
5. impaired synthesis of ADH
6. damage to the supraoptic paraventricular nucleus
7. Failure of Vasopressin expenditure
8. Pathophysiology

Arginine vasopressin is an antidiuretic hormone made in the supraoptic nucleus, paraventricular, and filiformis hypothalamus, together with the fastening of neurofisin II. Vasopressin and then transported from the cell bodies of neurons place of manufacture, through the axon toward the nerve endings in the posterior pituitary gland, which is a permanent storage. Physiologically, vasopressin and inactive neurofisin be secreted when there is a certain stimuli. Vasopressin secretion is regulated by stimuli that increased in volume and osmotic receptors. An increase in extracellular fluid osmolality or decreased intravascular volume will stimulate the secretion of vasopressin. Vasopressin and then increase the permeability of renal collecting duct epithelium of the water through a mechanism that involves activation of adenolisin and increase cyclic AMP. As a result, increased urinary concentration and decreased serum osmolality. Serum osmolality is usually kept constant by a 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 due to reduced permeability, which would lead to polyuria or a lot of piss.
In addition, the increase in plasma osmolality stimulates the thirst center right, and conversely decrease in plasma osmolality will suppress the thirst center. Excitatory threshold osmotic thirst center is higher than the threshold of vasopressin secretion stimuli. Therefore, when plasma osmolality increases, then the body will first be overcome by secreting vasopressin was still rising when it will stimulate the thirst center, which will have implications for the person to drink a lot (polydipsia).

In pathogenesis, diabetes insipidus is divided into 2 of central diabetes insipidus, in which disturbances in vasopressin itself and nephrogenic diabetes insipidus, where interference is not responsive because the kidney tubules to vasopressin.

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

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


Etiology
There are several circumstances which result in central diabetes insipidus, including the tumors in the hypothalamus, pituitary tumors and destroy large nucleus-hypothalamic nuclei, head trauma, injury, surgery on the hypothalamus, the intracerebral vascular occlusion, and disease granuomatosa .

Clinical symptoms
Complaints and the main symptoms of diabetes insipidus are polyuria and polydipsia. Total production of urine or liquid you drink 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 solutes arising from impaired thirst stimuli.
Diabetes nephrogenic (DI)
DIN is diabetes insipidus that is not responsive to exogenous ADH
Etiology

Nephrogenic diabetes insipidus can be caused by several things:
1. Chronic kidney disease
Polycystic kidney disease
Medullary cystic disease
Pielonefretis
Ureteral obstruction
Advanced renal failure
2. Electrolyte disturbances
Hypokalemia
Hypercalcaemia

3. Drugs
lithium
demoksiklin
asetoheksamid
tolazamid
glikurid
propoksifen
4. sickle cell disease
5. dietary disorders

Diagnosis
There is a way to diagnose the cause of the polyuria is due to diabetes insipidus, not because of other diseases. The trick is to answer three questions that we can know to diagnose and examination.
First, what causes polyuria that is revenue such material (in this case water) is excessive to the kidneys or excessive spending. If the diagnose is found that the patient was drinking a lot, then it's only natural that polyuria occurs.
Second, whether the cause of this polyuria was renal factor or not. Polyuria can occur in acute kidney failure in diuresis when the healing period. However, if polyuria is due to acute kidney failure, then there will be a history of oliguria (little pee).
Third, Is the main ingredients that make up the urine in polyuria was water without or with substances that are dissolved. In general, polyuria due to diabetes insipidus removing pure water, but did not rule found any solutes. If found dissolved materials in the form of high glucose levels (abnormal) then it can be suspected that the polyuria is caused by diabetes mellitus, which is one Differential Diagnosis of diabetes insipidus.
Examination Support
If we suspect the cause of polyuria are diabetes Insipidua, it must conduct tests to support diagnosis and to distinguish whether the type of diabetes insipidus is experienced, because the management of these two different types of diabetes insipidus.There are several checks on diabetes insipidus, among others:

1.Hickey Hare or Carter-Robbins
2.Fluid deprivation
3.Nicotine test
Regardless of the examination, the principle is to know the volume, specific gravity, or the concentration of urine. As for knowing its type, can provide a synthetic vasopressin, on the Central diabetes insipidus will be a decrease in amount of urine, and in nephrogenic diabetes insipidus did not happen.

Management
Treatment of diabetes insipidus should be in accordance with the symptoms it causes. In patients with partial DIS thirst mechanism without nocturia and polyuria symptoms that disrupt sleep and daily activities are not required specific therapy.
In a complete DIS, hormone replacement therapy is usually required (hormonal replacement) DDAVP (1-desamino-8-d-arginine vasopressin) which is the main option. In addition, adjuvant therapy can also be used to regulate water balance, such as:

• Thiazide diuretics
• Chlorpropamide
• Klofibrat
• Carbamazepine