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Aims: Desmopressin has been reported to be effective as an adjuvant to opioids or NSAIDs in management of pain in renal colic; however real-life data are lacking on the utilisation of desmopressin in this patient segment., Methods: The Danish National Prescription Registry data-linked with Danish National Patient Registry during a 3-year period from 2009 to 2011 was used to study prescriptions for desmopressin in renal colic., Results: We identified 888 desmopressin prescriptions for renal colic, dispensed to 95 patients. The mean treatment period was 159 days, with a large variation up to a maximum of 924 days. Approximately two thirds of patients received dosing instructions to administer the drug 4 times daily to provide 24-h antidiuretic coverage. Among concomitant opioids and NSAIDs, tramadol and ibuprofen were prescribed most frequently. Antidepressants and diuretics were also widely used. A clear sex difference was seen, with female renal colic patients having three times more prescriptions overall than males, and in particular receiving more antidepressants and psychotropic drugs. A total of 4 (4.2%) of the patients experienced hospital admissions because of hyponatraemia or polydipsia during the 3-year period. We confirmed a previous case report that nephrolithiasis could be at least an occasional complication of successful therapy of Central Diabetes Insipidus (CDI) with desmopressin, identifying 12 CDI patients in total, or 2.4% of all Danish CDI patients in that period, who were also treated for renal colic., Conclusion: In summary, these real-life prescription data provide exact epidemiological measures on desmopressin utilisation in renal colic., (Copyright © 2015 John Wiley & Sons, Ltd.)

The urine-concentrating mechanism performs one of the most essential functions in water and electrolyte metabolism and serves primarily to maintain extracellular osmolality within a very narrow range. The history of anti-diuresis dates back more than 100 years and includes the discovery of antidiuretic hormone (AVP), the renal AVP receptor, and most recently the water channel (aquaporin) proteins. Today, the mechanisms of antidiuresis are understood on a highly detailed molecular level including both short term and long-term regulation of AQP2 function. Furthermore, the background behind many acquired and inherited disturbances of water balance has now been revealed and has enabled a precise differential diagnosis. These include different forms of diabetes insipidus, nocturnal enuresis and nocturia in the elderly. Diabetes insipidus represents a dramatic but rare disturbance of water balance caused by deficient AVP secretion (neurogenic), reduced renal sensitivity to AVP (nephrogenic), an abnormally high fluid intake (primary polydipsia), or in rare cases by placental enzymatic degradation of AVP (gestational). Nocturnal enuresis and nocturia in the elderly represents much more common disturbances and share common pathogenic features including an abnormally high nocturnal urine production. This seems at least in part to be caused by abnormally low levels of plasma AVP during night. The increased understanding of such water balance disturbances have changed dramatically prior treatment practice by introducing antidiuresis as a treatment modality. The ongoing progress in our understanding of antidiuresis may provide the basis for the development of new antidiuretic compounds.