Diabetes Insipidus (DI): Differentials

by Carlo Raj, MD

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    00:00 get a single question wrong.

    00:01 Now with these differentials, we have taken a look at these before, but the parameters here are a little a bit different, but incredibly important. Let me set this up. We have the condition and the differentials in the first column. We will have the blood pressure went only relevant to your pathology. PRA stands for plasma renin activity and the aldosterone magnesium only once relevant and urine calcium when it is only relevant. That what you find in red is what you truly paying attention to because that unique for that particular pathology. Blue is going to be the consequence of. So let us begin. In Bartter syndrome, where is my pathology? It is going to be in the thick ascending limb. It is a problem with the sodium, potassium to chloride, isn't it? So you are going to have issues with what exactly? You are going to have issues with your concentrating ability and diluting ability.

    00:53 What else to talk about the Bartter syndrome? We said that there would be increase in prostate glandins. So, therefore, one step of management a border, in fact, is indomethacin. In addition, Bartter syndrome has a unique feature in which I want to go to last column here where the urine calcium is elevated, elevated, elevated. On this entire table of differentials, Bartter syndrome is going to be the only one that you and I are going to see as having hypercalciuria.

    01:24 So, therefore, is it possible just possible that you might have secondary hypoparathyroidism? Yes or no? Good. Yes. You will have secondary hypoparathyroidism. Now in Bartter syndrome, there would be an increase in aldosterone and because of that, you would have a decrease in plasma renin activity. Keep that in mind. Let's move on.

    01:49 In Gitelman syndrome, where are you? My problem is in the thiazide-sensitive. You remember that your sodium channel cotransporter T gene. T representing the thiazide-sensitive. Here right off the back with Gitelman, I want you to go to urine calcium. You see the difference.

    02:06 Here you find your calcium to be really low and with Gitelman, the two big things here is an increase in PRA, plasma renin activity and an increase in aldosterone. Now in addition to your urine calcium being quite low, the serum magnesium will be low. There is enough information here with Gitelman and once again in terms of electrolytes and the pathophysiology, you should not be able to get or you should be able to answer any question confidentially and of the two conditions here, Gitelman and Bartter, what is more, common in our society? Gitelman, Gitelman, Gitelman. So you want to spend a little bit more time on Gitelman in getting these facts down because it is much more common than Better. But I can clearly say that both are commonly asked. Liddle syndrome is interesting. With Liddle syndrome, all that you want to know is the labs here and that would be good enough for you to get any question right. I don't want to be in a situation where every once in a while you are doing a question and you might not know one condition, but do not know two or three conditions is rather frustrating. Liddle syndrome, you will find an increase in blood pressure and you will find a decrease in plasma renin activity and aldosterone.

    03:22 That is the forest you need to go now with Liddle know that it exists. Now SIADH, we talked about this earlier. We will then find an increase in ADH. You are then going to find an increase in blood pressure. In SIADH, you will not find pitting edema euvolemic.

    03:41 You have a decrease in aldosterone and a decrease in plasma renin activity. Once again what did I say? Euvolemic. Why? It is SIADH. Is that really reabsorbing or secreting sodium any of that functioning here? No. So sodium is not going to be part of the equation when you have that fluid accumulation. That is interesting and should be known. In Conn's syndrome, what is my problem? It is the primary adrenal cortex in which you are only producing.

    04:10 You see that arrow in orange. That is my primary problem. Too much aldosterone, decrease in plasma renin activity, your patient has what kind of hypertension? Secondary hypertension and then we have reninoma. Reninoma where is your problem? Where do you begin? Take a look at the orange arrow. It is plasma renin activity first and with that occurring understand that your blood pressure here is, in fact, going to be increased. This is then called secondary once again hypertension. Two very important tables they give you a bunch of differentials that are then affecting the kidney in some way, shape or form, this table might or might not be too familiar. Make it familiar. All these labs will be shown and it is important that you come up with good differentials. You will be impressed.

    About the Lecture

    The lecture Diabetes Insipidus (DI): Differentials by Carlo Raj, MD is from the course (Nephrogenic) Diabetes Insipidus (DI).

    Included Quiz Questions

    1. Blood pressure
    2. Plasma renin activity
    3. Urine Ca concentration
    4. Serum magnesium concentration
    5. Plasma aldosterone concentration
    1. Bartter syndrome
    2. Gitelman syndrome
    3. Conn syndrome
    4. SIADH
    5. Liddle syndrome
    1. Liddle syndrome
    2. SIADH
    3. Bartter syndrome
    4. Reninoma
    5. Conn syndrome

    Author of lecture Diabetes Insipidus (DI): Differentials

     Carlo Raj, MD

    Carlo Raj, MD

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