title: Treatment of congenital nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride in an adult patient.
abstract: 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.
authors.affiliation: 2nd Department of Internal Medicine, Kanazawa University School of Medicine, Kanazawa, Japan. konosita@fmsrsa.fukui-med.ac.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Konoshita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kuroda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawane
authors.forename: Ichiro
authors.initials: I
authors.lastname: Koni
authors.forename: Isamu
authors.initials: I
authors.lastname: Miyamori
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tofuku
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mabuchi
authors.forename: Ryoyu
authors.initials: R
authors.lastname: Takeda
mesh_terms: 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
chemical_list: D004232:Diuretics; D006852:Hydrochlorothiazide; D000584:Amiloride