Central diabetes insipidus unmasked by kidney transplantation: a case report and literature review

Background: Diabetes insipidus (DI) is a relatively uncommon abnormality of water homeostasis resulting in the excess production of hypotonic polyuria. Post-transplant polyuria is typically self-limited and resolves without intervention. We present a case of severe and persistent post-transplant polyuria secondary to previously undiagnosed central DI. Methods: A case of persistent polyuria following kidney transplant is presented, demonstrating the diagnosis and management of central DI following kidney transplant. A literature review of central DI after kidney transplant was performed to provide context of this extremely rare condition. Results: A 59-year-old female with chronic kidney disease received a pediatric en bloc kidney transplant, and exhibited massive polyuria for five days following transplant. Desmopressin therapy resulted in resolution of the polyuria, but labile sodium levels resulted in the development of a seizure. Imaging demonstrated an empty sella supporting the diagnosis of central DI. A total of five prior case reports of DI after kidney transplantation, the majority which were diagnosed prior to kidney transplant, and typically in patients with prior intracranial surgery. Conclusion: While early polyuria is frequent following kidney transplant, persistent massive polyuria requires further workup, and DI should be considered.