Diabetes insipidus (DI) is a rare medical condition that disrupts the body's ability to regulate water, resulting in excessive thirst and an unusually high volume of urine. This condition affects the kidneys' ability to concentrate urine and causes individuals to produce between 3 and 20 quarts of dilute, colourless urine daily, compared to an average of 1 to 2 quarts. It is pertinent to note that DI is not related to diabetes mellitus, which disrupts the body's insulin production.

Types Of Diabetes Insipidus

This condition results from damage to the hypothalamus or pituitary gland, which impairs the production or release of vasopressin, a hormone responsible for water retention. When vasopressin levels are inadequate, the kidneys fail to conserve water, leading to excessive urination. It can result from Brain injuries or surgeries, tumours, infections or inflammation and aneurysms.

Nephrogenic Diabetes Insipidus

This type occurs when the kidneys fail to respond to vasopressin, causing excessive fluid loss. Common triggers include chronic kidney disease, and electrolyte imbalances, such as high calcium or low potassium levels. Additionally, medications like lithium

and urinary tract blockages can also cause Nephrogenic DI.

Gestational Diabetes Insipidus

A rare condition seen only during pregnancy, this occurs when the placenta produces an enzyme that breaks down vasopressin or increases prostaglandin levels, reducing kidney sensitivity to the hormone. Symptoms of this are usually mild and often resolve postpartum but can recur in future pregnancies.

Symptoms And Warning Signs

• Severe thirst, often leading to the consumption of over a gallon of water daily
• Frequent urination (polyuria), sometimes exceeding 20 quarts per day
• Nighttime urination and bed-wetting
• Weakness, muscle pain, and preference for cold drinks

In severe cases, dehydration may develop, manifesting as fatigue, dizziness, dry mouth, confusion, nausea, or fainting. Infants and children with DI may exhibit crankiness, poor feeding, slow growth, fever, or vomiting.

Causes And Risk Factors

DI stems from issues with vasopressin production or response. Central DI arises from damage to brain structures, while nephrogenic DI relates to kidney dysfunction. Risk factors include:

- Genetic mutations affecting water regulation

- Certain medications like diuretics or lithium

- Metabolic disorders that alter calcium or potassium levels

- Brain injuries or surgeries

Diagnosis And Testing

Diagnosing DI involves a combination of medical history, physical exams, and specialized tests:

- Urinalysis: Evaluates urine concentration and glucose levels to distinguish DI from diabetes mellitus.

- Blood tests: Check electrolyte, glucose, and vasopressin levels.

- Water deprivation test: Measures changes in weight, blood sodium, and urine concentration during fluid restriction.

- MRI: Detects abnormalities in the hypothalamus or pituitary gland.

- Genetic screening: Identifies inherited risk factors.

Although DI is rare, affecting about 1 in 25,000 people, early diagnosis and targeted treatment can significantly improve quality of life. Researchers continue to explore its causes and treatments to better support those living with this challenging condition.

One of the most common contributing factors in lung cancer is smoking but a recent report suggests an alarming pattern in which cases among non-smokers are on the rise.

Pope Leo XIV was recently diagnosed with lung adenocarcinoma, a type of aggressive cancer that develops in the cells lining the lungs. He had no history of smoking. The 71-year-old pontiff underwent surgery to have part of his right lung lobe removed. According to reports, he is out of the hospital and recovering well.

Another case is of Stanford physician Bryant Lin whose stubborn cough led him to seek medical attention. After six weeks, he underwent an X-ray. The diagnosis stated that he had stage 4 lung cancer. Lin was less than a month away from turning 50, and he had never smoked a cigarette in his entire life.

“Definitely a shock,” Lin recalled according to The Washington Post. By the time doctors identified the cancer in spring 2024, it had spread to his liver, bones and brain.

According to the US Centers for Disease Control and Prevention (CDC), around 10% to 20% of lung cancers in the United States are reported in people who have never smoked or have smoked fewer than 100 cigarettes in their lifetime. That amounts to an estimated 20,000 to 40,000 cases annually.

For these patients, their no-smoking history can delay diagnosis and treatment. Hence, researchers are now looking into how environmental exposures, genetic causes and the biology of tumours may contribute to lung cancer in non-smokers.

Lung Cancer In People Who Have Never Smoked

Also read: Pope Leo XIV, Diagnosed With Lung Cancer, Undergoes Surgery As His Brother Battles Relapsed Multiple Myeloma

Smoking remains the leading risk factor for lung cancer. But other reasons like exposure to radon, secondhand smoke, air pollution and asbestos can also increase risk. Family history plays a role, especially when a first-degree relative has cancer before age 50.

Researchers are also examining genetic differences that may help explain why some people develop lung cancer despite never smoking.

A study published in September identified a rare genetic mutation concentrated in the southeastern United States that was associated with a 60-fold higher risk of lung cancer among non-smokers. The finding focuses on a possible role for inherited susceptibility, but it does not explain most cases in this group.

Lung cancer also has a different demographic profile among people who have never smoked. Women who have never smoked are more than twice as likely as their male counterparts to develop lung cancer.

“Two-thirds of nonsmoking-related lung cancer happens in women, so there’s certainly an association with female sex,” said Jaclyn LoPiccolo, a medical oncologist at Dana-Farber Cancer Institute who co-authored the mutation study.

She added, “Nonsmoking-related lung cancer is also more common in people of East Asian descent, but whether that’s a genetic or environmental association, we don’t yet know.”

These Cancers Are Often Diagnosed Late

Also read: Pope Leo XIV Resumes Daily Activities After Lung Cancer Surgery: How Recovery Looks Like After Lung Lobe Removal

People who have never smoked may not recognise a persistent cough or other respiratory symptoms as signs of lung cancer. Doctors may initially consider more common explanations if the patient has no smoking history.

Never-smokers are often diagnosed late at more advanced stages of the disease because their doctors initially consider lung cancer to be less likely.

Haiying Cheng, a medical oncologist at Montefiore Einstein Medical Center in New York, said the stigma surrounding the disease can compound the problem. “A cancer diagnosis should never become a judgment about a patient,” Cheng said.

She added that clinicians need to consider assumptions beyond smoking when it comes to lung cancer and focus on the patient’s risk profile and tumour biology.

Lin is receiving antibody therapy targeting a cancer-driving mutation. He had a positive response to treatment.

“The treatment has done wonders for me,” he said. “When I was a medical student or resident, I would have never thought a Stage 4 lung cancer patient could be very productive and have a high quality of life almost two-and-a-half years after diagnosis.”

In the United States, the US Preventive Services Task Force recommends annual low-dose CT screening for adults aged 50 to 80 who have a smoking history. People who have never smoked are not included in these recommendations.

As researchers dig deeper into lung cancer chances in non-smokers, there is growing interest in different screening recommendations. Taiwan, for example, has a national early-detection programme offering low-dose CT scans to non-smokers with a family history of lung cancer.

Lin has urged his own sons to consider screening at a younger age. “I’ve got two sons, and I told them, ‘When you hit 45 or even 40, think about getting screened,’” he said.

Many women in their forties come to my clinic with joint pain they have lived with for months, assuming it is part of getting older. World Arthritis Day is a good time to look at what changes in a woman's joints after 40 and why it pays to act early.

Why Does The Risk Rise After 40?

The biggest shift is hormonal. Oestrogen helps regulate inflammation and protects cartilage, bone and muscle. As levels fluctuate during perimenopause and fall after menopause, the joints lose part of that protection. A 2024 review in the journal Climacteric named this pattern the musculoskeletal syndrome of menopause, estimating that more than 70% of women experience joint or muscle symptoms during the transition and about one in four find them disabling.

Lower oestrogen also speeds up the loss of muscle and bone. When the thigh muscles weaken, the knee absorbs more shock with every step, which is one reason knee osteoarthritis becomes more common in women at this stage. Osteoarthritis, the gradual wear of the cartilage cushioning the bones, commonly affects the knees, hips, hands and spine. Old injuries, excess weight, and family history increase the risk.

Women are also two to three times more likely than men to develop rheumatoid arthritis, an autoimmune condition in which the immune system attacks the joint lining. It most often begins between the ages of 30 and 60.

Which Signs Should You Watch For?

One simple check is how long your joints stay stiff in the morning. Stiffness and pain that increases with movement is typical of osteoarthritis. Stiffness even with rest, especially with swelling in the small joints of both hands or wrists, suggests inflammatory arthritis and needs prompt assessment. Other signs include pain while climbing stairs or getting up from the floor, a grating feeling in the knee, firm bony swellings on the finger joints and tiredness out of proportion to your activity.

Not every ache after 40 is arthritis. Menopause-related pain, for instance, tends to move around the body. An examination, an X-ray, and simple blood tests can tell these conditions apart, so avoid self-diagnosis.

How Can You Protect Your Joints?

• Strength training: Muscle-strengthening exercise at least twice a week, focused on the thighs and hips, takes load off the knees.
• Low-impact activity: Walking, swimming, and cycling keep joints mobile without straining them.
• Weight: A study of adults with knee osteoarthritis found that every kilogram lost takes about four kilograms of load off the knee with each step.
• Diet: Get enough protein and calcium, and ask your doctor whether you need a vitamin D test.
• Daily habits: If your knees already hurt, limit deep squatting and long hours sitting cross-legged on the floor, wear supportive footwear, and avoid smoking.

When Should You See A Doctor?

Consult an orthopaedic specialist if joint pain or stiffness lasts beyond a few weeks or affects daily tasks. In rheumatoid arthritis, early treatment can slow the disease and prevent permanent joint damage. A suddenly hot, red, swollen joint with fever needs same-day attention, as it may signal infection.

Arthritis does not have to come with turning 40. Women who notice the early signs, keep their muscles strong, and see a doctor in time can stay active and independent well into later life.

By Dr Saurabh Bansal, Consultant Orthopaedic Surgeon, PB Health

Holding urine occasionally, such as during a long meeting or traffic jam, is generally not harmful for most healthy adults. However, repeatedly delaying urination for extended periods may affect urinary health, particularly in people who are prone to urinary tract infections (UTIs) or have existing bladder problems.

What Happens When You Hold Urine for Too Long?

When urine remains in the bladder for too long, it can become uncomfortable and may contribute to bladder overdistension. In some individuals, particularly those with underlying urinary retention or bladder dysfunction, regularly postponing urination may worsen existing problems.

While holding urine does not directly cause a UTI in every case, incomplete bladder emptying can increase the risk of infection.

Also read: Are People With CKD At Higher Risk Of Dementia And Cognitive Problems?

Why You Should Not Reduce Water Intake to Avoid Bathroom Break

People who work long hours or commute frequently should try to respond to the urge to urinate rather than routinely suppressing it.

Maintaining adequate hydration is equally important, as deliberately drinking less water to avoid bathroom breaks can lead to concentrated urine and may increase the risk of certain urinary problems like concentrated urine leading to crystallization and stone formation.

When Should You Seek Medical Advice?

If you experience persistent urgency, burning during urination, lower abdominal discomfort, difficulty passing urine or blood in the urine, seek medical advice. Developing regular bathroom habits and ensuring convenient access to washrooms can help support long-term urinary health.

It is also important to recognise when urinary symptoms may indicate a more serious problem. Inability to pass urine despite a strong urge, particularly when accompanied by severe lower abdominal pain or swelling, requires urgent medical attention.

Fever, chills or pain in the back or side alongside urinary symptoms may indicate a kidney infection and should be assessed promptly. Avoid assuming that such symptoms are simply the result of holding urine for too long.

By Dr. Vikram Kalra, Principal Director - Nephrology and Kidney Transplant, Aakash Healthcare Multi Speciality Hospital, Dwarka