DIAGNOSTICS AND TREATMENT OF DIABETES INSIPIDUS ON THE EXAMPLE OF A CLINICAL CASE

Today, there is a tendency towards an increase in the prevalence of diabetes insipidus with the same frequency, both in women and in men. The main peak of morbidity was in the second - third decade of life. The problem of diabetes insipidus is associated with impaired synthesis, secretion or action of vasopressin, manifested by the excretion of large quantities of urine with low relative density, dehydration and thirst. Vasopressin is secreted by the neurohypophysis, the most important biological effect of which is the preservation of water in the body by reducing urine excretion by increasing water reabsorption in the distal renal tubules, where it increases the hydroosmatic permeability of the tubular membrane. The article presents a clinical case from the nephrological department of pediatrics, in which a male patient, at the age of 15 years, was diagnosed with diabetes insipidus. From the anamnesis it is known that the manifestations of the disease were noted from the age of 3. The department carried out a diagnostic search to determine the genesis of diabetes insipidus. At the first stage, a fluid restriction test was performed, the results of which excluded primary polydipsia. At the second stage of diagnosis, a desmopressin test was performed to separate the genesis of diabetes insipidus. According to the results of which, an increase in the relative density of urine by more than 50% was not observed. In this connection, therapy with hypothiazide and indomethacin was prescribed, with a positive effect.

diabetes insipidus, vasopressin, desmopressin, dry eating test, polyuria, polydipsia, relative density

1. Дедов И. И. Открытое проспективное клиническое исследование по оценке эффективности и безопасности применения десмопрессина в форме назального спрея у пациентов с центральным несахарным диабетом: фармакоэкономические аспекты /И. И. Дедов, Е. А. Пигарова, Л. Я. Рожинская //Леч. врач. -2010. - №9. - С. 2-5.

2. Дзеранова Л. К. Несахарный диабет. Эндокринология: Нац. рук. /Под ред. И. И. Дедова, Г. А. Мельниченко. - М.: ГЭОТАР-Медиа, 2008. - С. 673-677.

3. Дзеранова Л. К. Центральный несахарный диабет: современные аспекты диагностики и лечения /Л. К. Дзеранова, Е. А. Пигарова //Леч. врач. - 2006. - №10. - С. 42-47.

4. Пигарова Е. А. Несахарный диабет: эпидемиология, клиническая симптоматика, подходы к лечению //Доктор.ру. - 2009. - №6. - С. 16-19.

5. Пигарова Е. А. Центральный несахарный диабет: дифференциальная диагностика и лечение /Е. А. Пигарова, Л. К. Дзеранова, Л. Я. Рожинская. - М.: Анита-Пресс, 2010. - 36 с.

6. Пигарова Е. А. Центральный несахарный диабет: патогенетические и прогностические аспекты, дифференциальная диагностика: Автореф. дис..канд. мед. наук. - М., 2009. - 24 с.

7. Стребкова Н. А. Федеральные клинические рекомендации по диагностике и лечению несахарного диабета у детей и подростков. - М., 2013. - 244 с.

8. Центральный несахарный диабет: дифференциальная диагностика и лечение: Метод. рекомендации /Под ред. И. И. Дедова, Г. А. Мельниченко. - М., 2010. - 36 с.

9. Эндокринология: Нац. рук. /Под ред. И. И. Дедова, Г. А. Мельниченко. - М.: ГЭОТАР-Медиа, 2008. - 1 072 с.

10. Bichet D. G. Nephrogenic Diabetes Insipidus: Vasopressin Receptor Defect //Genetic Diseases of the Kidney /Edited by R. P. Lifton, S. Somlo, G. Giebsch, D. W. Seldin. - NY, 2009. - P. 341-349.

11. Bockenhauer D. Diabetes Insipidus // The Kidney: Comprehensive Pediatric Nephrology: MOSBY, 2008. - P. 489-498.

12. Congenital nephrogenic diabetes insipidus - vasopressin and prostaglandinsinrespons to treatment with hydrochlorothiazide and indomethacin /W. Rascher, W. Rosendahl, I. A. Henrichs et al. // Pediatr. Nephrol. - 1987. - V. 1(3). - P. 485-490.

13. Jakobsson В. Effect of hydrochlorothiazide andindomethacine treatment оп renal function in nephrogenic diabetes insipidus /В Jakobsson, U. Berg //Acta Paediatr. - 1994. - V. 83(5). - P. 522-525.

14. Knoers N. Nephrogenic diabetes insipidus /N. Knoers, E. N. Levtchenko. - Berlin-Heidelberg: Springer-Verlag, 2016. - 432 p.

15. Vasopressin and desmopressin in central diabetes insipidus: adverse effects and clinical considerations /R. J. Kim, C. Malattia, M. Allen et al. //Pediatr. Endocrinol. Rev. - 2004. - V. 2. - P. 115-123.