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Nephrogenic diabetes insipidus (NDI) is characterized by polyuria with polydipsia, recurrent bouts of fever, constipation, and acute hypernatremic dehydration after birth that may cause neurological sequelae. Polyuria may exceed 10 liters in children.
Features include always present findings: Nephrogenic diabetes insipidus; and very common findings: Hyposthenuria, Hypernatremia, and Hypernatremic dehydration. 21 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Digestive system | 4 | Feeding difficulties, Nausea and vomiting, Constipation |
Hereditary nephrogenic diabetes insipidus (NDI) should be suspected in an individual with the following clinical and laboratory findings.
Clinical
Polyuria (excessive urine production)
Polydipsia (excessive drinking)
Family history of NDI
No approved treatments are currently available for nephrogenic diabetes insipidus. The disease remains an area of unmet medical need.
To establish the extent of disease in an individual diagnosed with hereditary nephrogenic diabetes insipidus (NDI), the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 2.
Recommended Evaluations Following Initial Diagnosis in Individuals with Hereditary Nephrogenic Diabetes Insipidus
There are no published guidelines available on recommended surveillance for children or adults with hereditary NDI. The frequency of follow up should take into consideration the medications being used and compliance with medications and diet recommendations.
Table 3.
Recommended Surveillance for Individuals with Hereditary Nephrogenic Diabetes Insipidus
System/Concern | Evaluation | Frequency
3 clinical trials registered, 2 recruiting. Interventions under study include other interventions, drug therapy, and procedural interventions. Pipeline includes 1 PHASE1, 1 NA. Research is sponsored by a mix of industry and academic institutions.
93 publications have been identified in PubMed for nephrogenic diabetes insipidus. Research spans Case Report / Case Series (45%), Review / Meta-Analysis (26%), and Basic Science / Preclinical (16%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 42 |
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 11:55 AM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Growth and development
3 |
Short stature, Failure to thrive, Growth delay |
Brain and nerves | 2 | Global developmental delay, Seizure |
Kidneys and urinary system | 2 | Nephrogenic diabetes insipidus, Reduced kidney function (renal insufficiency) |
Hormones | 1 | Nephrogenic diabetes insipidus |
Metabolism | 1 | Fever |
Hereditary nephrogenic diabetes insipidus (NDI). Individuals with NDI typically have polyuria and polydipsia. However, in infants, polydipsia and polyuria are often unappreciated or unremarkable. Infants usually present with poor feeding, poor weight gain, and irritability. Infants are eager to suck but may vomit during or shortly after feeding. Dehydration is evident with dryness of the skin, loss of normal skin turgor, recessed eyeballs, increased periorbital folding, depression of the anterior fontanel, and a scaphoid abdomen. Intermittent high fever is a common complication of dehydration, predominantly in very young children. Seizures can occur but are rare and most often seen during therapy, particularly if rehydration proceeds too rapidly.
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
Note: In the first few months after birth, polyuria and polydipsia may not be immediately noticed; infants with NDI usually present with poor feeding, failure to thrive, and irritability.
Laboratory
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
Diabetes insipidus is the excretion of abnormally large volumes (i.e., 50 mL/kg body weight in 24 hours) of dilute urine (i.e., specific gravity 1.010 or osmolality 300 mOsm/kg). In addition to hereditary nephrogenic diabetes insipidus (NDI), causes of diabetes insipidus include the following:
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
System/Concern | Evaluation | Comment
| Kidney ultrasound exam | To evaluate for hydronephrosis, dilatation of urinary tract, megacystis
| • Consultation w/clinical geneticist /or genetic counselor
Developmental eval in children w/history of episode of severe dehydration or delay in diagnosis
|
Management is usually best accomplished by a team consisting of a nutritionist, a pediatric (or adult) nephrologist or endocrinologist, and a clinical geneticist. General management. The essence of management is the provision of free access to drinking water and to toilet facilities. Infants, who are naturally unable to seek out water when thirsty, must be offered water between regular feedings. Children and adults who are heavy sleepers may need to be awakened at night by a family member or an alarm clock in order to drink water and to urinate. As long as an individual's thirst mechanism remains intact and the person is otherwise well, these measures prevent hypernatremic dehydration.
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
Water intake must not be restricted.
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
In a few individuals with a milder AVPR2 pathogenic variant resulting in a partial response to AVP and DDAVP®, high doses of DDAVP® in combination with a thiazide diuretic significantly decreased urinary volume . Effectiveness and safety of this treatment in partial NDI need to be explored further. Because of the known gastrointestinal safety of selective cyclooxygenase (COX)-2 inhibitors compared to nonselective COX inhibitors (e.g., indomethacin), use of these drugs has been proposed for the treatment of hereditary NDI. The effectiveness of a specific COX-2 inhibitor in decreasing free water losses was demonstrated in male infants with hereditary NDI .
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
3 trials found
| Monitoring of growth development | At least every:
3 mos in infants
6 mos in older children
| Measurement of serum sodium concentration to identify unrecognized hyperosmolality early dehydration1 | At least every:
3 mos in infants
6 mos in older children
Annually in adults or only as needed, as determined on an individual basis
Kidney ultrasound exam to monitor for hydronephrosis megacystis | Annually
1. Urine output and urine specific gravity are useless as indicators of hydration status.
Source: GeneReviews — "Hereditary Nephrogenic Diabetes Insipidus"
Phenotype severity distribution: 1 always present feature, 3 very common features, 6 common features.
Estimated prevalence: 1-9 in 1,000,000 (Rare).
Research summaries | 24 | 26% |
Laboratory research | 15 | 16% |
Disease patterns and progression | 9 | 10% |
New treatment approaches | 2 | 2% |
Other research | 1 | 1% |
Motomura Y (2026). [PMID: 42064718](https://pubmed.ncbi.nlm.nih.gov/42064718/). *JCEM Case Rep*. [Case Report / Case Series]
Zeng Y (2026). [PMID: 41921879](https://pubmed.ncbi.nlm.nih.gov/41921879/). *J Affect Disord*. [Epidemiology / Natural History]
Dąbek M (2026). [PMID: 41598788](https://pubmed.ncbi.nlm.nih.gov/41598788/). *J Clin Med*. [Review / Meta-Analysis]
Uygun İlikhan S (2026). [PMID: 41948060](https://pubmed.ncbi.nlm.nih.gov/41948060/). *Case Rep Nephrol*. [Case Report / Case Series]
Huang Y (2026). [PMID: 41982965](https://pubmed.ncbi.nlm.nih.gov/41982965/). *Transl Pediatr*. [Case Report / Case Series]
Banerjee S (2026). [PMID: 39992531](https://pubmed.ncbi.nlm.nih.gov/39992531/). *Indian J Pediatr*. [Basic Science / Preclinical]
Yan T (2026). [PMID: 41559973](https://pubmed.ncbi.nlm.nih.gov/41559973/). *Medicine (Baltimore)*. [Review / Meta-Analysis]
Aksoy ÖY (2026). [PMID: 41986963](https://pubmed.ncbi.nlm.nih.gov/41986963/). *J Paediatr Child Health*. [Case Report / Case Series]
Madariaga L (2026). [PMID: 40924182](https://pubmed.ncbi.nlm.nih.gov/40924182/). *Pediatr Nephrol*. [Review / Meta-Analysis]
Acharya S (2026). [PMID: 41809951](https://pubmed.ncbi.nlm.nih.gov/41809951/). *Eur J Case Rep Intern Med*. [Case Report / Case Series]