TY - JOUR
T1 - Perioperative management of central diabetes insipidus in kidney transplantation
AU - Henne, T.
AU - Bökenkamp, A.
AU - Offner, G.
AU - Ehrich, J. H.H.
PY - 2001
Y1 - 2001
N2 - Central diabetes insipidus is clinically masked in dialysis patients. We report a 12-year-old girl receiving a living-related donor graft for renal failure from Alport syndrome, in whom a craniopharyngioma had been resected 6 months before transplantation. Pre-transplant evaluation had documented central hypothyroidism, growth hormone deficiency, and presumptive hypogonadotropic hypogonadism. The corticotropin-releasing factor test had been normal. Four hours after transplantation, urine output exceeded 1,000 ml/h without diuretic therapy. Serum sodium concentration was 155 mmol/l, serum osmolality 333 mmol/kg, and plasma antidiuretic hormone 4.9 ng/l, while urine osmolality was 233 mmol/kg. Desmopressin acetate was started by continuous intravenous infusion at 1 μg/day. Serum electrolytes rapidly normalized, urine output stabilized at 2 1/day. The patient was discharged 4 weeks after transplantation with good allograft function, receiving intranasal desmopressin acetate 10 μg twice daily. Pre-existing central diabetes insipidus is unmasked after successful kidney transplantation, leading to rapid dehydration and hypernatremia, which can be prevented by prompt institution of desmopressin therapy.
AB - Central diabetes insipidus is clinically masked in dialysis patients. We report a 12-year-old girl receiving a living-related donor graft for renal failure from Alport syndrome, in whom a craniopharyngioma had been resected 6 months before transplantation. Pre-transplant evaluation had documented central hypothyroidism, growth hormone deficiency, and presumptive hypogonadotropic hypogonadism. The corticotropin-releasing factor test had been normal. Four hours after transplantation, urine output exceeded 1,000 ml/h without diuretic therapy. Serum sodium concentration was 155 mmol/l, serum osmolality 333 mmol/kg, and plasma antidiuretic hormone 4.9 ng/l, while urine osmolality was 233 mmol/kg. Desmopressin acetate was started by continuous intravenous infusion at 1 μg/day. Serum electrolytes rapidly normalized, urine output stabilized at 2 1/day. The patient was discharged 4 weeks after transplantation with good allograft function, receiving intranasal desmopressin acetate 10 μg twice daily. Pre-existing central diabetes insipidus is unmasked after successful kidney transplantation, leading to rapid dehydration and hypernatremia, which can be prevented by prompt institution of desmopressin therapy.
KW - Central diabetes insipidus
KW - Kidney transplantation
KW - Perioperative management
UR - http://www.scopus.com/inward/record.url?scp=0035058581&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s004670100571
DO - https://doi.org/10.1007/s004670100571
M3 - Article
C2 - 11354773
SN - 0931-041X
VL - 16
SP - 315
EP - 317
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 4
ER -