Skip to main content

Advertisement

Log in

Triamterene in lithium-induced nephrogenic diabetes insipidus: a case report

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Lithium-induced nephrogenic diabetes insipidus (NDI) is a rare and difficult-to-treat condition. We describe the case of an 81-year-old woman with bipolar treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to disturbance of consciousness and was diagnosed with, hypercalcemia, hyperparathyroidism, and NDI. Parathyroidectomy was contraindicated and parathyroid hormone level was improved insufficiently after cinacalcet initiation, percutaneous ethanol injection therapy was performed for the enlarged parathyroid gland. After improvement in hypercalcemia and unsuccessful indapamide treatment, triamterene was administrated to control polyuria. Lithium is one of the indispensable maintenance treatment options for bipolar disorder, but it has the side effect of NDI. Lithium enters the collecting duct’s principal cells mainly via the epithelial sodium channel (ENaC) located on their apical membranes, ENaC shows high selectivity for both sodium and lithium, is upregulated by aldosterone, and inhibited by triamterene. To our knowledge, this is the first publication on triamterene use in lithium-induced NDI patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Daniel G, Bichet MD, Detlef Bockenhauer MD. Genetic forms of nephrogenic diabetes insipidus (NDI): vasopressin receptor defect (X-linked) and aquaporin defect (autosomal recessive and dominant). Best Pract Res Clin Endocrinol Metab. 2016;30:263–76.

    Article  Google Scholar 

  2. de Groot T, Sinke AP, Kortenoeven ML, et al. Lithium-induced NDI: acetazolamide reduces polyuria but does not improve urine concentrating ability. J Am Soc Nephrol. 2016;27:2082–91.

    Article  Google Scholar 

  3. Timmer RT, Sands JM, et al. Lithium intoxication. J Am Soc Nephrol. 1999;10:666–74.

    CAS  PubMed  Google Scholar 

  4. Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatr Clin North Am. 2019;66:227–34.

    Article  Google Scholar 

  5. Halenka M, Frysak Z, Koranda P, et al. Ultrasound-guided percutaneous ethanol injection therapy in a 92 year-old patient with parathyroid adenoma and with a history of total thyroidectomy for parillary thyroid carcinoma. Acta Endocrinol. 2016;12:349–54.

    CAS  Google Scholar 

  6. Hestbech J, Hansen HE, Amdisen A, et al. Chronic renal lesions following long-term treatment with lithium. Kidney Int. 1977;12:205–13.

    Article  CAS  Google Scholar 

  7. Richard T, Sands JM. Lithium intoxication. JASN. 1999;10:666–74.

    Google Scholar 

  8. Thomsen K, Shirley DG. A hypothesis linking Na and Li reabsorption in the distal nephron. Nephrol Dial Transpl. 2006;21:869–80.

    Article  CAS  Google Scholar 

  9. Kellengerger S, Schild L. Epithelial sodium channels/degenerin family of ion channels: a variety of functions with a shared structure. Physiol Rev. 2002;82:735–67.

    Article  Google Scholar 

  10. Kwon TH, Laursen UH, Marples D, et al. Altered expression of renal AQPs and Na+ transporters in rats with lithium-induced NDI. Am J Physiol Renal Physiol. 2000;279:F552–F56464.

    Article  CAS  Google Scholar 

  11. Nielsen S, Frokiaer J, Marples D, et al. Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002;82:205–44.

    Article  CAS  Google Scholar 

  12. Rojek A, Nielsen J, Brools HL, et al. Altered expression of selected genes in kidney of rats with lithium-induced NDI. Am J Physiol Renal Physiol. 2005;288:F1276–F12891289.

    Article  CAS  Google Scholar 

  13. Macleod MD, Bell GM, et al. Nephrogenic diabetes insipidus associated with dyazide (triamterene-hydrochlorothiazide). Br Med J (Clin Res Ed). 1981;283:1155–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Koji Mitsuiki.

Ethics declarations

Conflict of interest

The authors have declared no competing interests.

Human and animal rights

The study complies with the ethical guidelines of the 1975 Declaration of Helsinki.

Informed consent

Informed consent was obtained from the individual included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoue, M., Nakai, K. & Mitsuiki, K. Triamterene in lithium-induced nephrogenic diabetes insipidus: a case report. CEN Case Rep 10, 64–68 (2021). https://doi.org/10.1007/s13730-020-00517-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-020-00517-2

Keywords

Navigation