Critical Care Medicine-Endocrine Disorders>>>>>Pituitary
Question 3#

Which of the following is NOT associated with nephrogenic diabetes insipidus (DI)?

A. Amphotericin B
B. Lithium
C. Hyperkalemia
D. Hypercalcemia

Correct Answer is C


Correct Answer: C

Nephrogenic DI is caused by an improper response of the kidney to ADH, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water. This differs from central DI, which is caused by insufficient levels of ADH, usually due to decreased secretion from the posterior pituitary. 

Common causes of nephrogenic DI include hereditary mutations, chronic lithium ingestion, hypercalcemia, and hypokalemia. Hereditary mutations include the x-linked vasopressin V2 receptor gene mutation and the aquaporin-2 gene mutation that has both autosomal dominant and recessive modes of inheritance. Lithium exerts its effect by disrupting the aquaporin-2 water channel. Hypercalcemia and hypokalemia decrease collecting tubule responsiveness to ADH, as well as decrease sodium chloride reabsorption in the thick ascending limb.

Other causes of nephrogenic DI include a variety of renal disease (sickle cell disease or trait, polycystic kidney disease, renal amyloidosis, and Sjogren syndrome), drugs (cidofovir, foscarnet, amphotericin B, ofloxacin, orlistat, and didanosine), pregnancy, and craniopharyngioma surgery. 


  1. Garofeanu CG, Weir M, Rosas-Arellano MP, et al. Causes of reversible nephrogenic diabetes insipidus: a systematic review. Am J Kidney Dis. 2005;45:626.
  2. Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol. 2015;11:576.