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Generalidades de la Diabetes Insípida Central y Nefrogénica
Overview of Central and Nephrogenic Diabetes Insipidus
Edición XXIV Mayo - Agosto 2023
DOI: https://doi.org/10.55139/KESJ4390
Dra. María Paula Pacheco Salas
Médico y Cirujano
Investigadora independiente, San José, Costa Rica.
Dra. Amanda Coto Quirós
Médico y Cirujano
Investigadora independiente, San José, Costa Rica.
Dr. Manrique Sauma Montes de Oca
Médico y Cirujano
Investigador independiente, San José, Costa Rica.
Dr. Kevin Villarevia Umaña
Médico y Cirujano
Investigador independiente, San José, Costa Rica.
Resumen
La diabetes insípida (DI) es una enfermedad caracterizada por poliuria y polidipsia. Puede ser de origen central o nefrogénica, y en casos raros inducida por el embarazo. La DI central resulta de la deficiencia hormona antidiurética (ADH), mientras la DI nefrogénica resulta de la resistencia renal a la ADH. En ambos casos, las causas adquiridas son mucho más comunes que las causas genéticas o hereditarias. Es una enfermedad poco frecuente, con prevalencia de 1:25 000, que no tiene predilección por sexo y se puede presentar a cualquier edad. Debido a que los síntomas son los mismos que para polidipsia primaria, diferenciar entre ambas conlleva un reto diagnóstico. Clásicamente se utiliza el test de deprivación de agua de dos pasos. La capacidad de medición de copeptina por sí misma y posterior a infusión de solución salina hipertónica han mejorado la precisión diagnóstica de la enfermedad. Se debe buscar la causa de la enfermedad con base en la sospecha diagnóstica, ya que dar un tratamiento a un diagnóstico errado puede tener consecuencias graves. La base del tratamiento farmacológico de DI nefrogénica son los diuréticos tiazídicos, mientras que para la DI central es la desmopresina, un análogo de la ADH.
Palabras claves
Diabetes insípida, diabetes insípida nefrogénica, diabetes insípida central, síndrome poliuria polidipsia.
Abstract
Diabetes insipidus (DI) is a disease characterized by polyuria and polydipsia. It can occur due to antidiuretic hormone (ADH) deficiency in central DI; due to a renal resistance to ADH in nephrogenic DI, and in rare cases induced by pregnancy. Causes of both are usually acquired. It is a rare disease, with a prevalence of 1:25000, which has no predilection by sex and can be present at any age. Symptoms for DI and primary polydipsia are the same, so distinguishing between both can be challenging. Classically, the two-step water deprivation test is used. The ability to measure copeptin by itself and its measure after an infusion of hypertonic solution have improved diagnostic accuracy of the disease. An appropriate diagnostic and its cause should be done based on clinical suspicion, since misleading the diagnosis and treating it wrongly can have serious consequences. The mainstay of drug treatment for nephrogenic DI is thiazide diuretics, while for central DI it is desmopressin, an ADH analogue.
Keywords
Diabetes insipidus, nephrogenic diabetes insipidus, central diabetes insipidus, poliuria-polydipsia syndrome.
Bibliografía
1. Christ-Crain M, Bichet DG, Fenske WK, Goldman MB, Rittig S, Verbalis JG, et al. Diabetes insipidus. Nature Reviews Disease Primers [Internet]. 2019;5(1):54. Available from: http://dx.doi.org/10.1038/s41572-019-0103-2
2. Christ-Crain M, Gaisl O. Diabetes insipidus. Presse Médicale [Internet]. 2021;50(4):1-11. Available from: http://dx.doi.org/10.1016/j.lpm.2021.104093
3. Refardt J, Winzeler B, Christ-Crain M. Diabetes insipidus: An update. Endocrinology Metabolism Clinics of North America [Internet]. 2020;49(3):517–31. Available from: http://dx.doi.org/10.1016/j.ecl.2020.05.012
4. Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatric Clinics of North America [Internet]. 2019;66(1):227–34. Available from: http://dx.doi.org/10.1016/j.pcl.2018.09.006
5. Priya G, Kalra S, Dasgupta A, et al. Diabetes insipidus: A pragmatic approach to management. Cureus [Internet]. 2021;13(1):e12498. Available from: http://dx.doi.org/10.7759/cureus.12498
6. Bichet D. Clinical manifestations and causes of nephrogenic diabetes insipidus. Up to Date. 2021; 1-22
7. Hureaux M, Vargas-Poussou R. Genetic basis of nephrogenic diabetes insipidus. Molecular and Cellular Endocrinology [Internet]. 2023;560(111825):111825. Available from: http://dx.doi.org/10.1016/j.mce.2022.111825
8. Mutter CM, Smith T, Menze O, Zakharia M, Nguyen H. Diabetes insipidus: Pathogenesis, diagnosis, and clinical management. Cureus [Internet]. 2021;13(2):e13523. Available from: http://dx.doi.org/10.7759/cureus.13523
9. Bichet D. Clinical manifestations and causes of central diabetes insipidus. Up to Date. 2022; 1-21.
10. Christ-Crain M, Winzeler B, Refardt J. Diagnosis and management of diabetes insipidus for the internist: an update. Journal of Internal Medicine [Internet]. 2021;290(1):73–87. Available from: http://dx.doi.org/10.1111/joim.13261
11. Christ-Crain M. Diabetes insipidus: New concepts for diagnosis. Neuroendocrinology [Internet]. 2020;110(9– 10):859–67. Available from: http://dx.doi.org/10.1159/000505548
12. Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clinical Endocrinology (Oxf) [Internet]. 2019;90(1):23–30. Available from: http://dx.doi.org/10.1111/cen.13866
13. Refardt J. Diagnosis and differential diagnosis of diabetes insipidus: Update. Best Practice & Research Clinical Endocrinology & Metabolism [Internet]. 2020;34(5):101398. Available from: http://dx.doi.org/10.1016/j.beem.2020.101398
14. Bichet D. Treatment of nephrogenic diabetes insipidus. Up to Date. 2021; 1-17.
15. Garrahy A, Thompson CJ. Management of central diabetes insipidus. Best Practice & Research Clinical Endocrinology & Metabolism [Internet]. 2020;34(5):101385. Available from: http://dx.doi.org/10.1016/j.beem.2020.101385
16. Bichet D. Treatment of central diabetes insipidus (vasopressin deficiency). Up to Date. 2021; 1-23.
17. Statlender L, Fishman G, Hellerman M, Kagan I, Bendavid I, Gorfil D, et al. Transient diabetes insipidus in critically ill COVID19 patients. Journal of Critical Care [Internet]. 2023;74(154211):154211. Available from: http://dx.doi.org/10.1016/j.jcrc.2022.154211
Esta obra está bajo una licencia internacional Creative Commons: Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)

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