Here is how it works: 1 Thiazides will increase the conc. In Diabetes insipidus which leads to dilute urine more water loss than salt. Less water has been reabsorbed through the distal renal tubules and collecting ducts water permeability decreased… while Na reabsorption through the Distal Renal tubules and Collecting ducts is normal so it gets back easily to the bloodstream. Therefore, the blood is going to be hyperconcentrated as water always follows sodium, lol, High Sodium concentration is going to pull water inside of the blood vessels causing high blood pressure due to the increase of blood volume and that situation would lead normally to dehydration so the role of the Thiazides is to regulate the electrolyte and fluid balance disorder.
Thiazides gonna help the patient to put out all the excess of Na from the blood through urine. According to my personal opinion, since Water is linked with Sodium, to eliminate one involves the elimination of both of them, the more you have Sodium in your blood, the more your urine gonna be.
Diuretic effect of Thiazides depend on high blood salt concentration, down to some level of salt concentration, diuretic effect may become less even the drug effect maybe reversed. Studies result might be controversial at this point because of cofounding bias, further studies must be done in this area.
In short, the Thiazides breaks the Polydipsia-Polyuria cycle. Also other good medicine for this to use is Desmopressin. There are also studies that show thiazides DO decrease plasma volume on the long-run. So this is still controversial. Actually, research in mice shows that this is the mechanism for thiazide-induced hypocalciuria. Save my name, email, and website in this browser for the next time I comment. Follow ASNKidney.
Read Later Share. I was reviewing the treatment of diabetes insipidus the other day, and was reminded of the paradoxical effect of thiazide diuretics on urine output in diabetes insipidus.
How does this work? The traditional thinking is that thiazide-induced blockade of the Na-Cl cotransporter in the distal tubule leads to a decrease in GFR. This decrease is compensated by an increase in proximal tubule sodium and water uptake. Because less water and solute are then delivered to the collecting duct, less water is lost as urine. A comparison of the effects of adrenalectomy and of chlorothiazide in experimental diabetes insipidus. J Endocrinol ; 22 : 77 — Skadhauge EI.
Acta Med Scand ; : — Earley LE, Orloff J. J Clin Invest ; 41 : — Takemura N. J Small Anim Pract ; 39 : — The antidiuretic effect of chronic hydrochlorothiazide treatment in rats with diabetes insipidus: renal mechanisms. Clin Sci Colch ; 63 : — Thiazide induces water absorption in the inner medullary collecting duct of normal and Brattleboro rats. Abstracts of the 7th International Congress of Nephrology , Montreal, Response to indomethacin and hydrochlorothiazide in nephrogenic diabetes insipidus.
Clin Sci ; 66 : — Effect of quinidine, prostaglandin E 2 , furosemide, and calmodulin antagonist on water and urea permeabilities of rat papillary collecting duct.
Granthan JJ, Orloff J. J Clin Invest ; 47 : — Alon U, Chan JC. Am J Nephrol ; 5 : 9 — Treatment of nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride. Arch Dis Child ; 80 : — Knoers N, Monnens LA. Nephrogenic diabetes insipidus: clinical symptoms, pathogenesis and treatment. Pediatr Nephrol ; 6 : — Nephrogenic diabetes insipidus. Semin Nephrol ; 19 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Introduction. Action of thiazide diuretics. The clinical use of thiazides in nephrogenic diabetes insipidus. Proposed mechanisms of action.
Microperfusion studies on the inner medullary collecting duct IMCD. Some practical points. New insights into the paradoxical effect of thiazides in diabetes insipidus therapy. Magaldi Antonio J. Oxford Academic. Google Scholar. Cite Cite Antonio J. Select Format Select format. Permissions Icon Permissions. Introduction One of the great advances in the therapy of renal disease occurred in the s and was the synthesis of orally administered diuretic compounds.
The clinical use of thiazides in nephrogenic diabetes insipidus Drugs are the most important causes of NDI [ 3 ]. Proposed mechanisms of action The following mechanism has been proposed to account for the effect of thiazides in this condition [ 6 , 8 ]. Open in new tab Download slide. Mechanism of action of the paradoxical effect of thiazide diuretics on NDI. J Am Chem Soc. Am J Physiol. Drug Saf. Proc R Soc Med. J Endocrinol. Acta Med Scand. J Clin Invest. J Small Anim Pract.
Clin Sci Colch. Abstracts of the 7th International Congress of Nephrology. Clin Sci. Abstracts of the 9th International Congress of Nephrology. Am J Nephrol. Arch Dis Child. Pediatr Nephrol. Semin Nephrol. Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal.
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