• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.431-434
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• 2005

Objective : Subarachnoid hemorrhage[SAH] is commonly associated with polyuria [solute diuresis or water diuresis]. The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. Methods : One hundred and forty eight patients with high urine output [>200ml/hr] after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis [diabetes insipidus, DI] was differentiated from solute diuresis by lower urine specific gravity [<1.005] and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. Results : Annual incidence of polyuria decreased markedly since July 2001 : 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in $2.4{\sim}11.1%$. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days [range $1{\sim}27$ days] and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. Conclusion : Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.

• Childhood Kidney Diseases
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• 제14권2호
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• pp.230-235
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• 2010

경정맥 고용량 스테로이드 충격요법(IMPT)의 부작용으로는 고혈압, 동성 서맥, 심방심실 전도장애, 심방 세동, 심방 조동, 심실 빈맥 등의 부정맥, 구토, 구역질 등의 소화기 장애, 백내장, 저칼륨혈증, 그리고 감염성 질환 등이 있다. 그중, 저칼륨혈증은 IMPT를 받는 환자의 17% 정도에서 경미하게 나타날 수 있다. 저칼륨혈증이 신수질의 요농축 능력을 저하시켜 다뇨가 발생할 수 있다는 사실은 이미 알려져 있지만, IMPT후 경미한 저칼륨혈증으로 인해 심한 야간뇨과 다뇨증이 발생하였다는 보고는 별로 없다. 이에 본 저자들은 다량의 단백뇨와 혈뇨를 보이는 HSP 신염환자에게 세 차례의 IMPT 시행 후 환아에게 발생한 경미한 저칼륨혈증으로 인한 심한 야간뇨와 다뇨증의 발생을 경험하였기에 이에 보고하는 바이다.

• Childhood Kidney Diseases
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• 제16권1호
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• pp.1-8
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• 2012

야간 다뇨는 야뇨증의 중요한 원인 중 하나로 거론된다. 소변 양을 조절하는 항이뇨호르몬의 일중 변동의 부적절한 조절, 고칼슘뇨증, 용질 이뇨가 야간 다뇨의 원인으로 생각되며, 이러한 기전들로 야간의 소변량이 많은 환자에서 방광용적이 상대적으로 작고 잠에서 깨어나기 어려운 경우 야뇨증이 발생한다. 야뇨증 환자에서 이러한 요인들을 평가하여 개개인에게 적절한 치료를 도입하여야 할 것이다.

• Childhood Kidney Diseases
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• 제24권1호
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• pp.42-46
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• 2020

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.

• Clinical and Experimental Pediatrics
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• 제49권1호
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• pp.99-102
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• 2006

윌름씨 종양은 주로 1-5세에 복부에 생기는 종양으로 약 25% 이상에서 고혈압을 동반하지만 심각한 고혈압에 의하여 심부전을 보이는 경우는 매우 드물다. 저자들은 3세된 여자 아이가 윌름씨 종양으로 인한 고레닌 혈증으로 다음, 다뇨, 저나트륨성 고혈압과 심부전을 보였으나 수술적으로 종양을 제거한 후 증상 호전을 보였기에 문헌 고찰과 함께 보고하는 바이다.

• 대한한의정보학회지
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• 제11권1호
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• pp.1-23
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• 2005

A symptoms of Diabetic is finded in many recordes, that is said to Diabetic or dryness or migratory arthralgia or flaccid paralysis of limb or abscess or arthralgia, but Diabetic is most closely symptom. So, study the 3-symptoms of Diabetes mellituscause, thses are polyuria and polyphasia and thirst, and this is similar symptoms of So-gal. So, bibliographic study or pathological approach of symptoms of So-gal, and So-gal in oriental medicine has come to the following conclution. The symptoms of So-gal is polyuria and polyphasia and thirst, is due to Simsinbulgyo, that is mean to breakdown of the normal physiological coordination between the heart and the kidney. A thirst is due to heat-transformation have an effect to the upper energizer and the heart and the lung and the stomach in Simsinbulgyo. A polyuria is due to failure of the kidneys Yang, that is due to failure of Yang of the heart in Simsinbulgyo.

• The Korean Journal of Physiology and Pharmacology
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• 제1권4호
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• pp.403-411
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• 1997

To elucidate the mechanism of gentamicin induced renal dysfunction, renal functions and activities of various proximal tubular transport systems were studied in gentamicin-treated rats (Fisher 344). Gentamicin nephrotoxicity was induced by injecting gentamicin sulfate subcutaneously at a dose of 100 $mg/kg{\cdot}day$ for 7 days. The gentamicin injection resulted in a marked polyuria, hyposthenuria, proteinuria, glycosuria, aminoaciduria, phosphaturia, natriuresis, and kaliuresis, characteristics of aminoglycoside nephropathy. Such renal functional changes occurred in the face of reduced GFR, thus tubular transport functions appeared to be impaired. The polyuria and hyposthenuria were partly associated with a mild osmotic diuresis, but mostly attributed to a reduction in free water reabsorption. In renal cortical brush-border membrane vesicles isolated from gentamicin-treated rats, the $Na^+$ gradient dependent transport of glucose, alanine, phosphate and succinate was significantly attenuated with no changes in $Na^+-independent$ transport and the membrane permeability to $Na^+$. These results indicate that gentamicin treatment induces a defect in free water reabsorption in the distal nephron and impairs various $Na^+-cotransport$ systems in the proximal tubular brush-border membranes, leading to polyuria, hyposthenuria, and increased urinary excretion of $Na^+$ and other solutes.

• Clinical and Experimental Pediatrics
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• 제59권4호
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• pp.202-204
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• 2016

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

• Childhood Kidney Diseases
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• 제11권1호
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• pp.112-117
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• 2007

저자들은 Leber의 선청성 흑암시를 진단받은 남매에서 성장 부전, 다음, 다뇨 및 야뇨증의 병력 없이 소아기에 만성 신부전으로 진행된 사춘기 콩팥 황폐증을 경험하여 우리나라에서는 드문 $Senior-L\ddot{o}ken$ 증후군을 보고하는 바이다.

• Childhood Kidney Diseases
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• 제25권1호
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• pp.35-39
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• 2021

Bartter syndrome is an autosomal recessive hypokalemic salt-losing tubulopathy, and classic Bartter syndrome is associated with mutations in the CLCNKB gene. While chronic hypokalemia is known to induce renal cyst formation in different renal diseases, renal cyst formation in Bartter syndrome is rarely reported. Russian six-year-old identical male twins were referred to our hospital for the evaluation of renal cysts, which were incidentally detected on abdominal sonography due to diarrhea. Both twins had shown symptoms of polydipsia, polyuria, and nocturia since they were one year olds. Vital signs including blood pressure were normal in both twins. Renal sonography revealed nephromegaly, increased echogenicity of renal cortex, and various sized multiple cysts in both kidneys for both twins. Laboratory findings included hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis. Bartter syndrome with renal cysts were suspected. Genetic analysis for both twins confirmed a homozygous c.1614delC deletion on exon 15 of the CLCNKB gene, which was confirmed as a previously unreported variant to the best of our knowledge. They were managed with potassium chloride, nonsteroidal anti-inflammatory drugs, and angiotensin-converting-enzyme inhibitors. Metabolic alkalosis, hypokalemia, hypochloremia, and polyuria partially improved during the short course of treatment. This is the first report of a homozygous mutation in the CLCNKB gene in an identical twin, presenting with renal cysts.