Pre- and post-treatment urinary tract findings in children with nephrogenic diabetes insipidus

Pediatr Nephrol. 2014 Mar;29(3):487-90. doi: 10.1007/s00467-013-2689-z. Epub 2013 Dec 14.


Background: Nephrogenic diabetes insipidus (NDI) is characterized by the kidney's inability to concentrate urine, which causes intense polyuria that may lead to urinary tract dilation. We report the morphological findings of the urinary tract in ten boys with NDI specifically addressing the presence and changes of urinary tract dilation during treatment.

Diagnosis/treatment: Patients were diagnosed at a median age of 1.6 years (range, 0.16-6.33 years) and treated with a low osmotic diet, hydrochlorothiazide-amiloride and indomethacin, which decreased the diuresis from a median of 10.5 ml/kg/h to 4.4 ml/kg/h (p < 0.001). Three patients showed normal renal ultrasound before treatment until last control, while the remaining seven showed urinary tract dilation. In this second group, dilation was reduced with treatment in four patients and disappeared in the remaining three. Children without dilation or in whom the dilation disappeared were diagnosed and treated earlier than those with persistent dilation (median 1.66 versus 4.45 years, respectively). After a median of 10.4 (range, 2.3-20.3) years of follow-up, no patients showed urological complications.

Conclusions: Medical treatment of the disease improved the dilation in all cases, preventing its potential complications. Regardless of the good outcome of our patients, periodic urologic follow-up is recommended in NDI patients.

MeSH terms

  • Amiloride / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Diabetes Insipidus, Nephrogenic / diagnosis
  • Diabetes Insipidus, Nephrogenic / diet therapy
  • Diabetes Insipidus, Nephrogenic / drug therapy
  • Diabetes Insipidus, Nephrogenic / physiopathology
  • Diabetes Insipidus, Nephrogenic / therapy*
  • Dilatation, Pathologic
  • Diuresis / drug effects
  • Diuretics / therapeutic use*
  • Drug Combinations
  • Humans
  • Hydrochlorothiazide / therapeutic use*
  • Indomethacin / therapeutic use*
  • Infant
  • Kidney Concentrating Ability / drug effects
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography
  • Urinary Tract / diagnostic imaging
  • Urinary Tract / drug effects*
  • Urinary Tract / pathology
  • Urinary Tract / physiopathology


  • Anti-Inflammatory Agents, Non-Steroidal
  • Diuretics
  • Drug Combinations
  • Hydrochlorothiazide
  • amiloride, hydrochlorothiazide drug combination
  • Amiloride
  • Indomethacin