Perioperative management of central diabetes insipidus in kidney transplantation.
Central diabetes insipidus is clinically masked in dialysis patients. We report a 12-year-old girl receiving a living-related donor graft for renal failure from Alport syndrome, in whom a craniopharyngioma had been resected 6 months before transplantation. Pretransplant evaluation had documented central hypothyroidism, growth hormone deficiency, and presumptive hypogonadotropic hypogonadism. The corticotropin-releasing factor test had been normal. Four hours after transplantation, urine output exceeded 1,000 ml/h without diuretic therapy. Serum sodium concentration was 155 mmol/l, serum osmolality 333 mmol/kg, and plasma antidiuretic hormone 4.9 ng/l, while urine osmolality was 233 mmol/kg. Desmopressin acetate was started by continuous intravenous infusion at 1 microgram/day. Serum electrolytes rapidly normalized, urine output stabilized at 2 l/day. The patient was discharged 4 weeks after transplantation with good allograft function, receiving intranasal desmopressin acetate 10 micrograms twice daily. Pre-existing central diabetes insipidus is unmasked after successful kidney transplantation, leading to rapid dehydration and hypernatremia, which can be prevented by prompt institution of desmopressin therapy.
Henne
T
T
Children's Hospital, Hannover Medical School, 30623 Hannover, Germany. butthenne42@hotmail.com
Bökenkamp
A
A
Offner
G
G
Ehrich
J H
JH
D002648:Child; D003397:Craniopharyngioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012076:Renal Agents / Q000627:therapeutic use
D012076:Renal Agents; D003894:Deamino Arginine Vasopressin