Question

You have a very unusual patient that has both nephrogenic diabetes insipidus and nephrotic syndrome. First, describe how this patient would appear (present) in your clinic. Second, describe the tests that you would order to confirm each of these diseases. Third, what is the course of treatment and medication that you would order for this patient.

Answer 1

Clinical features of diabetes insipidous :-

Polyuria, polydipsia, and nocturia are the predominant manifestations of diabetes insipidus (DI). The daily urine volume is relatively constant for each patient but is highly variable between patients, ranging from 3-20 L.

Clinical feature of nephrotic syndrome:-

Signs and symptoms of nephrotic syndrome include: Severe swelling (edema), particularly around your eyes and in your ankles and feet. Foamy urine, a result of excess protein in your urine. Weight gain due to fluid retention

Diagonostic test

For diabetes insipidous:-

Water deprivation test

Magnetic resonance imaging (MRI)

Genetic screening

urine and blood analysis

For nephrotic syndrome:-

Renal biopsy

Renal ultrasonography

Serum protein electrophoresis

Immunoglobulin A

Treatment

For Nephrogenic diabetes insipidus :-

Since the kidneys don't properly respond to ADH in this form of diabetes insipidus, desmopressin won't help. Instead, your doctor may prescribe a low-salt diet to help reduce the amount of urine your kidneys make. You'll also need to drink enough water to avoid dehydration.

Treatment with the drug hydrochlorothiazide (Microzide) may improve your symptoms. Although hydrochlorothiazide is a type of drug that usually increases urine output (diuretic), in some people it can reduce urine output for people with nephrogenic diabetes insipidus.

If your symptoms are due to medications you're taking, stopping these medicines may help. However, don't stop taking any medication without first talking to your doctor

For Nephrotic syndrome :-Treatment for nephrotic syndrome involves treating any medical condition that might be causing your nephrotic syndrome. Your doctor might also recommend medications and changes in your diet to help control your signs and symptoms or treat complications of nephrotic syndrome.

Blood pressure medications

Water pills (diuretics)

Cholesterol-reducing medications

Blood thinners (anticoagulants).

​​​​​​​Immune system-suppressing medications