Nephrogenic Diabetes Insipidus. An Unusual Presentation of Recurrent Rectal Cancer
|Title:||Nephrogenic Diabetes Insipidus. An Unusual Presentation of Recurrent Rectal Cancer|
|Authors:||Nobels, Frank; Colemont, Luc; Goethals, Marnix; Abs, Roger|
|Date Published:||November 01, 1991|
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This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
© Copyright NDI Foundation 2007 (JC)
Eight months after this 43-year-old male underwent radical surgery for his rectal cancer he began to display polyuria (the chronic passage of large amounts of urine) and polydipsia (chronic, excessive thirst). He was administered DDAVP, a synthetic analog of the antidiuretic hormone, arginine vasopressin (AVP), but this gave no relief of his symptoms. This indicated his diabetes insipidus (DI) was nephrogenic instead of neurogenic. Most DI in cancer patients is neurogenic because the cancer often affects the pituitary. The pituitary produces and excretes AVP, so if it can't do that, then there is no AVP to initiate urine concentration in, or water reabsorption through the kidney collecting ducts.
The authors discovered that this patient had a recurrent tumor in his pelvis that caused a partial obstruction of both ureters, which, the authors speculated, exerted undue pressure on the kidney collecting ducts. AVP must bind with vasopressin-2 receptors in the principal cells of the kidney collecting ducts if it is to initiate urine concentration and water reabsorption there. If it could not, due to pressure-induced damage, this could be the cause of the patient's NDI.