Treatment of congenital nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride in an adult patient.
OBJECTIVE
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.


CONCLUSIONS
HCTZ plus amiloride may be superior to HCTZ plus acemetacin and HCTZ plus triamterene in preventing hyperkaliuria, hypokalemia, and metabolic alkalosis.
Konoshita
Tadashi
T
2nd Department of Internal Medicine, Kanazawa University School of Medicine, Kanazawa, Japan. konosita@fmsrsa.fukui-med.ac.jp
Kuroda
Masahiro
M
Kawane
Takashi
T
Koni
Ichiro
I
Miyamori
Isamu
I
Tofuku
Yohei
Y
Mabuchi
Hiroshi
H
Takeda
Ryoyu
R
D000328:Adult; D000584:Amiloride / Q000627:therapeutic use*; D018500:Diabetes Insipidus, Nephrogenic / Q000151:congenital* / Q000188:drug therapy*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D008297:Male
D004232:Diuretics; D006852:Hydrochlorothiazide; D000584:Amiloride