Table Common Causes of Polyuria Mechanism Example Vasopressin - sensitive polyuria Decreased synthesis of vasopressin Primary arginine vasopressin deficiency, hereditary (usually autosomal dominant) Acquired (secondary) arginine vasopressin deficiency (causes outlined in text) Primary diabetes insipidus, hereditary associated with diabetes mellitus, optic nerve atrophy, nerve deafness, and atonia of bladder and ureters (Wolfram syndrome) Decreased release of vasopressin Primary polydipsia (dipsogenic diabetes insipidus) Vasopressin - resistant polyuria Renal resistance to vasopressin Congenital argininevasopressinresistance (usually X-linked recessive trait) Acquired arginine vasopressin resistance: Chronic kidney disease, systemic or metabolic disease (eg, myeloma, amyloidosis, hypercalcemic or hypokalemic nephropathy, sickle cell disease), certain medications (eg, lithium, demeclocycline) Osmotic diuresis Hyperglycemia (in diabetes mellitus) Poorly resorbed solutes (mannitol, sorbitol, urea) The water deprivation test is the simplest and most reliable method for diagnosing arginine vasopressin deficiency but should be done only while the patient is under constant supervision.