Causes of reversible nephrogenic diabetes insipidus: a systematic review.
BACKGROUND
In nephrogenic diabetes insipidus (NDI), the kidney is unable to produce concentrated urine because of the insensitivity of the distal nephron to antidiuretic hormone (arginine vasopressin). In settings in which fluid intake cannot be maintained, this may result in severe dehydration and electrolyte imbalances. The risk for conversion of reversible to irreversible NDI seems to be a potential complication. This review summarizes the reversible causes of acquired NDI to facilitate earlier recognition and more effective treatment by clinicians.


METHODS
Two reviewers independently searched MEDLINE, Experta Medica (EMBASE), and ISI bibliographic databases. Human studies that described NDI caused by drugs, substances, or metabolic disturbances were included. To evaluate the causal role of the risk factor, data were abstracted according to Koch's postulates.


RESULTS
One hundred fifty-five studies published between 1957 and March 2004 described 30 risk factors. Of 155 studies, 58 studies provided a "definite" diagnosis of NDI; 83 studies, a "probable" diagnosis; and 14 studies, a "possible" diagnosis. Nine factors were considered "definite" causes of NDI; 15 factors, "probable" causes; and 6 factors, "possible" causes. The most reported risk factors were lithium (84 studies), antibiotics (16 studies), antifungals (11 studies), antineoplastic agents (9 studies), antivirals (8 studies), and metabolic disturbances (8 studies). Duration of NDI reversal, as well as conversion to irreversible symptoms, seemed to depend on the duration of exposure.


CONCLUSIONS
Most risk factors for reversible NDI were medications, and their identification and removal resulted in resolution of the condition. Long-term treatment with lithium seemed to result in irreversible NDI.
Garofeanu
Camelia G
CG
Division of Nephrology, Walkerton Health Study, London Health Science Centre, Westminster Campus, Canada.
Weir
Mathew
M
Rosas-Arellano
M Patricia
MP
Henson
Garth
G
Garg
Amit X
AX
Clark
William F
WF
D000890:Anti-Infective Agents / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006934:Hypercalcemia / Q000150:complications; D007668:Kidney / Q000187:drug effects; D008094:Lithium / Q000009:adverse effects; D008659:Metabolic Diseases / Q000150:complications; D012307:Risk Factors
D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D008094:Lithium