Nephrogenic Diabetes Insipidus Due to Urinary Tract Obstruction: A Systematic Review

Mohammad Ali Raza Qizalbash, Rida Zahra, Abhinav Kumar, Adnan Adil, Kamran Khan, Sayed Tauseef Ahmad Jan, Shazia Shah, Shristi Shrestha, Ayeshah Sarfaraz, Amandeep Singh, Hamdan Gul


Background: Nephrogenic diabetes insipidus (NDI) due to obstructive uropathy is not widely known by physicians and hence not well represented in the literature. To better understand its presentation, clinical course, and available treatments, we conducted a systematic review of case reports on NDI due to urinary tract obstruction.

Methods: This observational study was a systematic review of 19 human cases found in the literature. It was done retrospectively to focus on whether NDI can occur due to obstruction of the urinary tract and, if so, what the mechanism (pathophysiology) is.

Results: We found that the most common symptom of NDI due to urinary tract obstruction was polyuria. The most common cause of NDI due to urinary tract obstruction was cancer. The most common site for obstruction was the ureter. And the most common test used to confirm the diagnosis was failure to concentrate urine after the administration of desmopressin. Surgical intervention was the most common treatment to relieve obstruction.

Conclusion: We found that urinary tract obstruction can cause NDI. With early diagnosis and timely relief of the obstruction, NDI can be reversible.


Nephrogenic Diabetes Insipidus, Obstructive Uropathy, Urologic Diseases, Diuresis

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Morello JP, Bichet DG. Nephrogenic diabetes insipidus. Annual review of physiology 2001;63:607-30 doi: 10.1146/annurev.physiol.63.1.607[published Online First: Epub Date].

Di Iorgi N, Napoli F, Allegri AE, et al. Diabetes insipidus--diagnosis and management. Hormone research in paediatrics 2012;77(2):69-84 doi: 10.1159/000336333[published Online First: Epub Date].

Roussak NJ, Oleesky S. Waterlosing nephritis, a syndrome simulating diabetes insipidus. The Quarterly journal of medicine 1954;23(90):147-64

Earley LE. Extreme polyuria in obstructive uropathy; report of a case of water-losing nephritis in an infant, with a discussion of polyuria. The New England journal of medicine 1956;255(13):600-605 [published Online First: Epub Date].

Landsberg L. Hypernatremia complicating partial urinary-tract obstruction. The New England journal of medicine 1970;283(14):746-8 [published Online First: Epub Date].

Kim SW, Cho SH, Oh BS, et al. Diminished renal expression of aquaporin water channels in rats with experimental bilateral ureteral obstruction. Journal of the American Society of Nephrology : JASN 2001;12(10):2019-28

Li C, Wang W, Knepper MA, et al. Downregulation of renal aquaporins in response to unilateral ureteral obstruction. American journal of physiology Renal physiology 2003;284(5):F1066-79 [published Online First: Epub Date].

Frokiaer J, Marples D, Knepper MA, et al. Bilateral ureteral obstruction downregulates expression of vasopressin-sensitive AQP-2 water channel in rat kidney. The American journal of physiology 1996;270(4 Pt 2):F657-68

Frokiaer J, Christensen BM, Marples D, et al. Downregulation of aquaporin-2 parallels changes in renal water excretion in unilateral ureteral obstruction. The American journal of physiology 1997;273(2 Pt 2):F213-23

Topcu SO, Norregaard R, Pedersen M, et al. Regulation of aquaporins and sodium transporter proteins in the solitary kidney in response to partial ureteral obstruction in neonatal rats. Urologia internationalis 2011;87(1):94-104[published Online First: Epub Date].

Murer L, Addabbo F, Carmosino M, et al. Selective decrease in urinary aquaporin 2 and increase in prostaglandin E2 excretion is associated with postobstructive polyuria in human congenital hydronephrosis. Journal of the American Society of Nephrology : JASN 2004;15(10):2705-12[published Online First: Epub Date].

Divas AIMia AJ, Yorio T. Aquaporins (water channels): role in vasopressin-activated water transport. Proceedings of the Society for Experimental Biology and Medicine Society for Experimental Biology and Medicine 1998;219(3):183-99

Gulmi FA, Matthews GJ, Marion D, et al. Volume expansion enhances the recovery of renal function and prolongs the diuresis and natriuresis after release of bilateral ureteral obstruction: a possible role for atrial natriuretic peptide. The Journal of urology 1995;153(4):1276-83

Ryndin I, Gulmi FA, Chou SY, et al. Renal responses to atrial natriuretic peptide are preserved in bilateral ureteral obstruction and augmented by neutral endopeptidase inhibition. The Journal of urology 2005;173(2):651-6[published Online First: Epub Date].

Purkerson ML, Blaine EH, Stokes TJ, et al. Role of atrial peptide in the natriuresis and diuresis that follows relief of obstruction in rat. The American journal of physiology 1989;256(4 Pt 2):F583-9

Kishimoto I, Dubois SK, Garbers DL. The heart communicates with the kidney exclusively through the guanylyl cyclase-A receptor: acute handling of sodium and water in response to volume expansion. Proceedings of the National Academy of Sciences of the United States of America 1996;93(12):6215-9

Fried TA, Osgood RW, Stein JH. Tubular site(s) of action of atrial natriuretic peptide in the rat. The American journal of physiology 1988;255(2 Pt 2):F313-6

Harris RH, Yarger WE. The pathogenesis of post-obstructive diuresis. The role of circulating natriuretic and diuretic factors, including urea. The Journal of clinical investigation 1975;56(4):880-7[published Online First: Epub Date].

Baum N, Anhalt M, Carlton CE, Jr., et al. Post-obstructive diuresis. The Journal of urology 1975;114(1):53-6

Sonnenberg H, Wilson DR. The role of the medullary collecting ducts in postobstructive diuresis. The Journal of clinical investigation 1976;57(6):1564-74 doi: 10.1172/JCI108427[published Online First: Epub Date].

Wilson DR. Micropuncture study of chronic obstructive nephropathy before and after release of obstruction. Kidney international 1972;2(3):119-30

Knoers N. Nephrogenic Diabetes Insipidus. In: Pagon RA, Adam MP, Ardinger HH, et al., eds. GeneReviews(R). Seattle (WA), 1993.

Miller M, Dalakos T, Moses AM, et al. Recognition of partial defects in antidiuretic hormone secretion. Annals of internal medicine 1970;73(5):721-9

Zerbe RL, Robertson GL. A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. The New England journal of medicine 1981;305(26):1539-46 [published Online First: Epub Date].


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