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Diabetes Insipidus

A. Definition
Diabetes insipidus is a rare disease . The disease is caused by a variety of causes that can interfere with the mechanism neurohy - pophyseal - renal reflexes in the body , resulting in a failure to convert the water . Most cases are idiopathic yangpernah encountered a case which can manifest in a variety of age groups and sex

B. Clinical symptoms
Complaints and symptoms of diabetes insipidus primary polyuria and polydipsia are . Total fluid intake and urine production per 24 hours very much , can reach 5-10 liters a day . Urine specific gravity is usually very low , ranging between 1001-1005 or 50-200 m0smol/kg weight . In addition to polyuria and polydipsia , there are usually no other symptoms unless there are other diseases that cause interference with the mechanism pophyseal neuropy - the - renal reflex .
During the thirst center remains intact patients , the concentration of dissolved substances in body fluids will be close to normal values ​​. New dangers arise if water intake can not compensate for the existing urine output by the patient will experience as a result of dehydration and increase in the concentration of dissolved substances .

C. Pathogenesis
In the pathogenesis of diabetes insipidus are divided into two types , namely central diabetes insipidus and nephrogenic diabetes insipidus .

1 . Central diabetes insipidus
Central diabetes insipidus ( DIS ) is caused by the failure of abti - diuretic hormone release ADH whose physiology may be a failure of synthesis or storage . In this anatomical abnormality occurs due to damage to the supraoptic nucleus , and paraventricular hypothalamus that synthesize ADH filiform . In addition DIS also arise due to disruption due to transportation of ADH supraoptikohipofisealis damage to axons and axon tracts in which the posterior pituitary ADH is stored at any time to be released into circulation if needed .
In biochemistry , DIS synthesis occurs in the absence of ADH , or ADH synthesis is not sufficient for quantitative , or quantitative enough but an ADH ADH can not function as normal . Synthesis neurofisin an abnormal binding protein , can also interfere with the release of ADH . In addition there is also suspected due to the presence of antibodies to the DIS ADH . Because the measurement of serum levels of ADH in radio immunoassay , which is a marker for ADH is physiologically neurofisin that does not work , then the normal or increased ADH can not be sure that it is a normal function of ADH or that causes diabetes insipidus by osmoreceptors damage contained on hipptalamus anterior and called Verney's osmoreceptor cells that are outside the blood-brain barrier .
2 . Nephrogenic diabetes insipidus
The term nephrogenic diabetes insipidus ( DIN ) is used in diabetes insipidus which is not responsive to exogenous ADH . Physiologically DIN can be caused by :
a. The failure of the establishment and maintenance of osmotic gradiens in the renal medulla
b . Failure utilization gradient on ADH are in a situation where sufficient quantities and functioning normally

Source :
Kowalak et al. 2012. Buku Ajar Patofisiologi. Jakarta: EGC

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