What is the recommended therapy for nephrogenic diabetes insipidus?

Nephrogenic diabetes insipidus (DI) occurs when the kidneys do not respond to antidiuretic hormone (ADH), leading to an inability to concentrate urine and resulting in polyuria and polydipsia. The recommended therapy focuses on addressing the underlying issue of the kidneys' insensitivity to ADH.

Hydrochlorothiazide is a thiazide diuretic that paradoxically can help reduce urine output in nephrogenic DI. It works by decreasing the delivery of sodium to the distal nephron, which, in turn, enhances water reabsorption despite the lack of ADH effect. Combining hydrochlorothiazide with indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), further improves the response by reducing renal blood flow and promoting water reabsorption.

In contrast, desmopressin is effective for central DI, where there is a deficiency of ADH production, but it does not have a beneficial effect in nephrogenic DI, as the kidneys are unable to respond to the hormone. Amiloride can help in cases where nephrogenic DI is caused by lithium toxicity but is not the first-line treatment for all cases of nephrogenic DI. Insulin replacement is