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Nephrogenic Diabetes Insipidus Dit Onderzoek Werd Gesubsidieerd Door De Nier Stichting Nederland

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Nephrogenic Diabetes Insipidus Dit Onderzoek Werd Gesubsidieerd Door De Nier Stichting Nederland PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/113799 Please be advised that this information was generated on 2021-10-11 and may be subject to change. Ί ND, XLRP 11 Y//. centromere 11 V////A 13 • 21 22 IGALA ALD G-6-PD Color blindness V.V.A.M.Knoers Nephrogenic Diabetes Insipidus Dit onderzoek werd gesubsidieerd door de Nier Stichting Nederland. Publikatie van dit proefschrift is mede mogelijk gemaakt door giften van het Fonds Wetenschapsbeoefening van de afdeling Kindergeneeskunde (St. Radboud Ziekenhuis, Nijmegen) en Ferring Pharmaceuticals. Nephrogenic Diabetes Insipidus een wetenschappelijke proeve op het gebied van de geneeskunde en tandheelkunde, in het bijzonder de geneeskunde PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Katholieke Universiteit te Nijmegen, volgens besluit van het college van decanen in het openbaar te verdedigen op vrijdag 8 juni 1990 des namiddags te 1.30 uur precies door VIRGINIE VICTOIRE ANNE MARIE KNOERS geboren op 9 augustus 1958 te Nijmegen Druk: 1990 SSN, Nijmegen Promotores: Prof. Dr. L.A.H. Monnens Prof. Dr. H.H. Ropers an Z 9α„£ Cover: Map of the X chromosome showing the position of the gene locus for Nephrogenic Diabetes Insipidus. CONTENTS page Chapter 1 General Introduction - Congenital Nephrogenic diabetes insipidus: The clinical picture - Pathophysiology 11 1.1 Congenital Nephrogenic Diabetes Insipidus: The clinical picture 12 1.1.1 History 12 1.1.2 Definition and Clinical manifestation 12 1.1.3 Diagnosis 14 1.1.4 Genetics 18 1.1.5 Treatment 19 1.2 Congenital Nephrogenic Diabetes Insipidus: Pathophysiology 23 1.2.1 Introduction 23 1.2.2 Antidiuretic hormone release 25 1.2.3 Build-up and maintenance of a cortico- papillary interstitial osmotic gradient 26 1.2.4 Modulation of water and solute transport by vasopressin 33 1.2.5 Extrarenal effects of vasopressin 45 1.2.6 Animal model of NDI 49 1.2.7 Possible mechanisms underlying the unres­ ponsiveness to antidiuretic hormone in NDI 51 1.3 References 54 1.4 Aim of the study 78 Chapter 2 Linkage of X-linked Nephrogenic Diabetes Insipidus with DXS52, a polymorphic DNA marker 81 2.1 Abstract 84 2.2 Introduction 84 2.3 Materials and Methods 85 2.4 Results 87 2.5 Discussion 89 2.6 References 90 7 page Chapter 3 Nephrogenic Diabetes Insipidus: Close linkage with markers from the distal long arm of the human X chromosome 93 3.1 Abstract 96 3.2 Introduction 96 3.3 Materials and Methods 97 3.4 Results 104 3.5 Discussion 105 3.6 References 108 Chapter 4 Three-point linkage analysis using multiple DNA polymorphic markers in families with X-linked Nephrogenic Diabetes Insipidus 113 4.1 Abstract 116 4.2 Introduction 116 4.3 Materials and Methods 117 4.4 Results and Discussion 118 4.5 References 121 Chapter 5 Fibrinolytic responses to l-desamino-8-D-arginine vasopressin in patients with congenital Nephroge­ nic Diabetes Insipidus 127 5.1 Abstract 130 5.2 Introduction 130 5.3 Materials and Methods 132 5.4 Results 133 5.5 Discussion 136 5.6 References 139 Chapter 6 A new variant of Nephrogenic Diabetes Insipidus: V2 receptor abnormality restricted to the kidney 143 6.1 Abstract 146 6.2 Introduction 146 6.3 Case Report 147 6.4 Methods 148 6.5 Results 150 8 page 6.6 Discussion 152 6.7 References 155 Chapter 7 Amiloride-Hydrochlorothiazide versus Indometha- cin-Hydrochlorothiazide in the treatment of Nephrogenic Diabetes Insipidus 159 7.1 Abstract 162 7.2 Introduction 162 7.3 Patients and Methods 163 7.4 Results 164 7.5 Discussion 168 7.6 References 171 Chapter 8 General Discussion 175 8.1 Diagnosis 176" 8.2 Pathogenesis 177 8.3 Treatment 180 8.4 Outlook:towards isolation of the NDI gene 182 8.5 References 188 Summary 197 Samenvatting 201 Dankwoord 205 Curriculum Vitae 207 9 CHAPTER 1 GENERAL INTRODUCTION - NEPHROGENIC DIABETES INSIPIDUS : THE CLINICAL PICTURE - PATHOPHYSIOLOGY 1.1 CONGENITAL NEPHROGENIC DIABETES INSIPIDUS: THE CLINICAL PICTURE 1.1.1 HISTORY The renal type of diabetes insipidus was appreciated as a separate clinical entity more then 40 years ago, when it was described in­ dependently by two investigators: Forssmann (1945) in Sweden and Waring et al. (1945) in the United States. In the next 15 years about 120 additional examples of the disorder were recognized and studied (Kaplan et al., 1959). Families with this type of defect, however, had been described many years before (Mc Ilraith, 1892), without being distinguished from the central or neurohormonal dia­ betes insipidus. The name 'Nephrogenic Diabetes Insipidus' was coined by Williams and Henry (1947), who noticed that injection of the antidiuretic hormone in doses, sufficient to induce systemic side effects, could not correct the concentrating defect. Subse­ quent studies revealed biologically active hormone to be present in the serum (Holliday et al., 1963) and urine (Luder and Burnett, 1954) of affected persons and lend further support to the theory of renal vasopressin unresponsiveness. Nowadays the name 'Nephrogenic Diabetes Insipidus' is used synony­ mously with the terms 'vasopressin or ADH-resistant diabetes insi­ pidus 'or 'diabetes insipidus renalis'. 1.1.2 DEFINITION AND CLINICAL MANIFESTATION Congenital Nephrogenic Diabetes Insipidus (NDI) is a rare inherited kidney disorder, characterized by insensitivity of the distal renal nephron to the antidiuretic effect of vasopressin (Williams and Henry, 1947). As a consequence, the kidney loses its concentrating ability and produces large volumes of hypotonic urine (50-100 mosm/ kg H2O), which may lead to severe dehydration and electrolyte imba­ lance (hypematremia and hyperchloremia). The osmolar urine/plasma (U/P) ratio remains constantly below 1 and cannot be reversed by exogenous application of vasopressin. As mentioned in the initial 12 descriptions by Waring et al. (1945), Forssman (1945), and Williams and Henry (1947), the defect in congenital NDI is present from birth and therefore manifestations of the disorder emerge within the first weeks of life. Polyuria, as high as 500 ml per day or even higher in infants, and excessive thirst are the most typical symptoms but they may not be recognized immediately (Gautier and Prader, 1956; Kaplan, 1987). Instead, the clinical picture is do­ minated by signs of chronic dehydration. Irritability, poor fee­ ding and poor weight gain are often the initial symptoms. Patients are eager to suck, but may vomit during or shortly after the fee­ ding. Dehydration is evidenced by dryness of the skin, loss of normal skin turgor, recession of the eyeballs, increased perior­ bital fold depth, recession of the anterior fontanelle and scaphoid abdomen. Intermittent high fever is a common complication of the dehydrated state (Waring et al., 1945; Forssman, 1945; Williams and Henry, 1947; Luder and Burnett, 1954; Ellborg and Forssman, 1955; Kaplan et al, 1959; Schoen, I960; Lobeck et al., 1963; Schräger et al., 1976), particularly in the neonate and infant. Therefore, frequently symptoms are considered to be caused by infection and many children with NDI are examined thoroughly for signs of bacte­ rial, viral or parasitic disease. It is not known how many cases remained undiagnosed during infancy and how many children have died without their disease being suspected. Seizures (Schoen, I960; Schultz and Lines, 1975, Kanzaki et al., 1985) are rare and are most often seen during therapy, particularly if rehydration pro­ ceeds too rapidly. Obstipation is a common symptom in children with congenital NDI (Luder and Burnett, 1954; Kirman et al., 1955; Ellborg and Forssman, 1955; Schoen, 1960; Lobeck et al., 1963; ten Bensei and Peters, 1970). Nocturia and enuresis (Schoen, 1960; Carter and Goodman, 1963; Miller and Winston, 1966; Ramsey et al., 1974; Monn, 1981) are frequent complaints later in childhood and it is not uncommon for patients to get up to drink 5 to 6 times during the night because of the intense thirst. Untreated, most patients fail to grow normally (Waring et al., 1945; Forssman, 1945; Williams and Henry, 1947; Ellborg and Forss­ man, 1955; Hillman et al., 1958; Kaplan et al., 1959; Schoen, 1960; 13 Vest et al., 1963) and some develop mental retardation (Forssman, 1955; Kirman et al., 1955;). Growth retardation is assumed to be directly related to polyuria and polydipsia (Hillman et al., 1958; Vest et al., 1963). Excessive fluid intake provokes anorexia and vomiting, which leads to malnutrition. Mental retardation, which can run the gamut from minor memory deficits to imbecility (Forss­ man, 1955), may be secondary to cerebral bleeding and brain damage caused by severe brain dehydration and hyperelectrolytemia occuring early in infancy (Macaulay and Watson, 1967; Kanzaki et al.,1985). Besides organic brain alterations, the psychological development of these children is influenced by a permanent craving for water and the urge for frequent voiding, which competes with playing and learning (Hillman et al., 1958). Therefore, many NDI patients are characterized by hyperactivity, distractibility, short attention span and restlessness. Long-lasting states of polyuria may favor the development of a me- gacystis (Shapiro et al., 1978) and , more rarely, hydroureter and hydronephrosis (Silverstein and Tobian, 1961; Carter and Goodman, 1963; Vest et al., 1963; ten Bensei and Peters, 1970), which can mimic lower urinary tract obstruction. 1.1.3 DIAGNOSIS The family history and the observation of polyuria in a dehydrated infant will usually provide all evidence necessary for presuming the diagnosis in an affected infant. To confirm the presence of polyuria and to distinguish the nephrogenic form of diabetes insi­ pidus from the central form, a vasopressin test is performed by intranasal application of l-desamino-8-D-arginine vasopressin (DDAVP) (Aronson and Svenningsen, 1974; Monnens et al., 1981; Kap­ lan, 1987) which is a synthetic analogue of the natural hormone and is characterized by a high and prolonged antidiuretic effect (Richardson and Robinson, 1985).
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