ESPN 51th Annual Meeting

ESPN 2018


 
CENTRAL DIABETES INSIPITUS IN A CASE WITH STEROID DEPENDENT NEPHROTIC SYNDROME
ZEHRA AYDIN 1 OZLEM YUKSEL AKSOY 1 FATMA SEMSA CAYCI 1 KIVANC TERZI 2 UMUT SELDA BAYRAKCI 1

1- ANKARA CHILDRENS HEALTH, HEMATOLOGY-ONCOLOGY TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- ANKARA CHILDRENS HEALTH, HEMATOLOGY-ONCOLOGY TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRICS
 
Introduction:

 Nephrotic syndrome is defined by marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. Underfill and the overfill hypotheses have been proposed to explain the occurrence of edema in the nephrotic syndrome. But the role of anti-diuretic hormone is not clear yet. Here we present a case with steroid dependent nephrotic syndrome (SDNS) who developed secondary central diabetes insipidus.

 

Material and methods:

 An 8-year-old boy who had been followed in our department with the diagnosis of SDNS, applied to our hospital with relapsed NS while he was on mycophenolate mofetil and prednisolone treatment. Urine examination revealed nephrotic range proteinuria. The patient was hospitalized and prednisolone 2 mg/kg/day was started. Proteinuria resolved after seven days of treatment, and complete remission was achieved. 

Results:

 A couple of days after remission, polydipsia and polyuria were observed. Urine density was 1002-1006. Meanwhile serum albumin, electrolytes, fractional sodium excretion and tubular phosphate reabsorption were normal. Urine osmolarity was 170 ng/mL while his urine volume was approximately  6 L/day. Cranial imaging was normal. After having a blood specimen for arginine vasopressin level, desmopressin acetate was started 60 mcg/day per oral. Urine density increased after desmopressin acetate treatment while, urine volume decreased. 

Conclusions:

 Central diabetes insipitus is rare in patients with nephrotic syndrome. This might be related with increased volume status of the patient with a nephrotic syndrome relapse. Further investigations are needed to explain the relationship of nephrotic syndrome and vasopressin.