From the Guidelines
The management of Nephrogenic Diabetes Insipidus (NDI) primarily involves free access to fluid to prevent dehydration, hypernatraemia, growth failure, and constipation 1.
Key Management Strategies
- Fluid intake: Patients with NDI should have ad libitum access to fluid to prevent dehydration and electrolyte imbalances 1.
- Dietary modifications: Reducing renal osmotic load by limiting salt and protein intake can help minimize urine volume 1.
- Medications:
- Thiazide diuretics, such as hydrochlorothiazide, can reduce polyuria by inducing mild volume depletion 1.
- Amiloride may be used in conjunction with thiazides to enhance their effect and prevent hypokalaemia 1.
- Indomethacin, a nonsteroidal anti-inflammatory drug, may also be used to reduce polyuria in patients with NDI 1.
Monitoring and Follow-up
- Regular monitoring of weight, fluid balance, and biochemistry is crucial to inform adjustments to treatment 1.
- Kidney ultrasound should be performed at least once every 2 years to monitor for dilatation of the urinary tract and/or bladder dysfunction caused by polyuria 1.
- Patients with NDI should be followed by a multidisciplinary team that includes a (paediatric) nephrologist, dietitian, psychologist, social worker, and urologist 1.
From the Research
Management of Nephrogenic Diabetes Insipidus (NDI)
The management of NDI involves a combination of non-pharmacological and pharmacological interventions. The goal of treatment is to decrease urine output, maintain fluid balance, and ensure an acceptable quality of life.
Non-Pharmacological Interventions
- Sufficient water intake to prevent dehydration and hypernatremia
- Low-sodium diet to reduce urine output
Pharmacological Treatment
- Thiazide diuretics, which can reduce polyuria in patients with NDI 2, 3, 4
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, which can decrease urine output and increase urine osmolality 5, 6
- Amiloride, which can be used in combination with thiazide diuretics to reduce polyuria and improve fluid balance 2, 3
- Desmopressin acetate (DDAVP), which may be effective in some patients with NDI, particularly those with certain genetic mutations 4
Treatment Approaches
- Combination therapy with thiazide diuretics and amiloride may be more effective and better tolerated than monotherapy 2
- Indomethacin may be a useful therapeutic tool for the treatment of lithium-induced NDI 5, 6
- Gene analysis may be helpful in selecting the most effective treatment approach and detecting NDI in siblings 4