Amiloride-Hydrochlorothiazide Versus Indomethacin-Hydrochlorothiazide in the Treatment of Nephrogenic Diabetes Insipidus

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Title: Amiloride-Hydrochlorothiazide Versus Indomethacin-Hydrochlorothiazide in the Treatment of Nephrogenic Diabetes Insipidus
Authors: Knoers, Nine; Monnens, Leo A.H.
Publisher: Journal of Pediatrics
Date Published: September 01, 1990
Reference Number: 337
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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)

The most effective pharmacological treatment to reduce the excessive urination caused by nephrogenic diabetes insipidus (NDI) has been a combination of hydrochlorothiazide (H), a diuretic, and indomethacin (I), a prostaglandin synthesis inhibitor. There are side effects to consider: prolonged use of H can deplete the body of potassium; prolonged use of I can cause gastrointestinal, central nervous, and kidney side effects. I can also interfere with the formation of blood cells.

Recent research indicates that the combination of H with amiloride (A) is an equally effective alternative with fewer side effects. A is a potassium sparing diuretic. It does not rob the body of potassium. Knoers and Monnens studied the relative effects of I-H and A-H on five male NDI patients aged 5 to 16. All were on a moderate-sodium diet and had free access to water during the test. For six days, they were treated with I-H, supplemented with potassium salt. For the next four days, they were treated only with H, supplemented with potassium salt. The next six days after that they were treated with A-H. Daily samples of blood and urine were taken and analyzed.

Both A-H and I-H were found to be equally effective in reducing urine output. Added advantages of A-H were: it lowered blood serum sodium levels; it required no potassium supplementation; it has only minor long-term side effects.

The antidiuretic action of A occurs in different part of the kidney than the antidiuretic action of H. These separate effects add together to reduce urine volume more than A or H used alone. The authors placed the patients on a regimen of A-H and performed follow up studies on them for a year. The authors concluded the A-H combination is a desirable way to treat congenital NDI.