Diabetes Inipidus: An Uncommon Disease

Diabetes insipidus (DI) is an uncommon disease that has the characteristic feature that an individual’s kidneys are passing an irregular volume of dilute urine that is insipid (without flavor). In 1794, Johann Peter Frank described the abnormal production of urine that was neither sweet nor linked to kidney disease (J.P. Frank et al., 1842). The discovery by Frank clarified the difference between diabetes insipidus and diabetes mellitus (high levels of sugar in the blood and urine), which at the time contradicted what was known and accepted by experts in this area that diabetes was a disease of the kidneys. This was the general state of knowledge that existed for almost a century until in 1892 when William Osler identified the cause of the …show more content…
Studies conducted by Stephen Walter Ranson demonstrated that a specific population of nuclei identified as the supraoptic nuclei of the hypothalamus had nerve projections that terminated in the posterior pituitary, and through animal studies, lesioning this tract of nerve fibers without failure produced DI (Fisher et al., 1938; Ranson 1937). A significant breakthrough came about through discovery of control and regulation of ADH release through experimental studies that investigated osmolality. Ernest B. Verney showed that by administering hypertonic solution into the carotid artery caused ADH release, the results of these experiments suggested that ADH was released in response to the sensing of osmolality by the hypothalamus (Pickford 1945; Verney …show more content…
The discovery of DI as a malfunction of the pituitary has led to the understanding of water balance and the crucial regulatory role of the hypothalamus for the highly precise control of osmolality and body fluid volume homeostasis through ADH release is critical to mammalian survival. Today, physicians and scientist identify three determinants of excessive urine excretion and dysregulated water balance in DI: dysregulation of ADH secretion, the unresponsiveness of the kidneys to ADH secretion and disorders of excessive fluid intake. In individuals whose controlled released of ADH has been compromised there is a lack of osmoregulation which results in the inability to concentrate urine; this type of DI is defined as cranial diabetes insipidus. The second known cause is nephrogenic diabetes insipidus. In this type of DI, the renal tubules are completely or partly resistant to ADH and this results in the reduction of water reabsorption by the kidneys. Studies have shown that genetic mutation or deletion of the gene that codes for the ADH receptor in the renal collecting duct which facilitates the intracellular control of insertion of water channels into the membrane of the renal tubular cells, these are called aquaporins. Genetic contributions are not the only cause of nephrogenic diabetes insipidus, any acquired disorder that is caused by osmotic