Treatment of nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride
Veronika Kirchlechner, Dieter Y Koller, Reiner Seidl, Franz Waldhauser
Department of
Pediatrics, University of Vienna, Währinger Gürtel 18-20, A-1090
Vienna, Austria
Correspondence to: Dr Waldhauser.
Accepted 9 February
1999
Nephrogenic diabetes insipidus (NDI) is characterised by the
inability of the kidney to concentrate urine in response to arginine vasopressin. The consequences are severe polyuria and polydipsia, often
associated with hypertonic dehydration. Intracerebral calcification, seizures, psychosomatic retardation, hydronephrosis, and hydroureters are its sequelae. In this study, four children with NDI were treated with 3 mg/kg/day hydrochlorothiazide and 0.3 mg/kg/day amiloride orally three times a day for up to five years. While undergoing treatment, none of the patients had signs of dehydration or electrolyte imbalance, all showed normal body growth, and there was no evidence of
cerebral calcification or seizures. All but one had normal psychomotor
development and normal sonography of the urinary tract. However, normal
fluid balance was not attainable (fluid intake, 3.8-7.7 l/m2/day; urine output,
2.2-7.4 l/m2/day). The treatment was well tolerated and
no side effects could be detected. Prolonged treatment with
hydrochlorothiazide/amiloride appears to be more effective and better
tolerated than just hydrochlorothiazide. Its efficacy appears to be
similar to that of hydrochlorothiazide/indomethacin but without their
severe side effects.
Keywords: hydrochlorothiazide; amiloride; nephrogenic diabetes insipidus; long term treatment
© 1999 by Archives of Disease in Childhood
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