34.下列何者最不可能造成腎性尿崩症（nephrogenic diabetes insipidus）？
(A)cidofovir
(B)foscarnet 
(C)hydrochlorothiazide
(D)lithium

【尿崩症治療小整理】

1. 中樞性尿崩症治療: Desmopressin
2. 腎因性尿崩症治療:  Thiazide類
3. 利尿劑Li+導致的尿 崩症治療: Amiloride(保鉀型利尿劑)

thiazide利尿劑 (hydrochlorothiazide 25 mg QD-BID)用於腎因性尿崩症的機轉：首先 thiazide利尿劑作用於遠曲小管，抑制NaCl co-transporter ，增加 Na+Cl-的排除，增加尿液的排除 (到這裡應該都沒問題)，然後這樣的結果會導致細胞外液 (extracellular fluid volume)減少 (如圖)，造成輕度血容量不足 (mild volume depletion, hypovolemia)，低血容量會降低 eGFR (腎絲球過濾率)、誘導近端腎小管 (proximal tubular)增加鈉水的再吸收，減少流到後端遠端腎小管、急尿管的水分，最後達到減少尿液的目的。

Nephrogenic DI can be caused by a number of drugs other than lithium. These include cidofovir and foscarnet which are used to treat cytomegalovirus infection in HIV-infected patients [61,62], and vasopressin V2 receptor antagonists, which induce a transient state of nephrogenic DI that can be used to treat hyponatremia and autosomal dominant polycystic kidney disease [63-65], amphotericin B, demeclocycline, ifosfamide, ofloxacin, orlistat, and didanosine [5,66]. Drug-induced nephrogenic DI is typically reversible, at least in part.


ref : UpToDate-Clinical manifestations and causes of nephrogenic diabetes insipidus