Polyuria

Polyuria (/ˌpɒliˈjʊəriə/) is excessive or an abnormally large production or passage of urine (greater than 2.5 L[1] or 3 L[6] over 24 hours in adults). Increased production and passage of urine may also be termed diuresis.[7][8] Polyuria often appears in conjunction with polydipsia (increased thirst), though it is possible to have one without the other, and the latter may be a cause or an effect. Primary polydipsia may lead to polyuria.[9] Polyuria is usually viewed as a symptom or sign of another disorder (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.

Not to be confused with polyurea or Frequent urination.
Polyuria
Other namesUrination - excessive amount[1]
Regulation of urine production by ADH and aldosterone
SpecialtyEndocrinology, nephrology
CausesPolydipsia, Psychogenic polydipsia[2][3]
Diagnostic methodUrine test and blood test[4]
TreatmentDepends on cause[5](See cause)

Causes

The most common cause of polyuria in both adults and children is uncontrolled diabetes mellitus,[6] which causes osmotic diuresis, when glucose levels are so high that glucose is excreted in the urine. Water follows the glucose concentration passively, leading to abnormally high urine output. In the absence of diabetes mellitus, the most common causes are decreased secretion of aldosterone due to adrenal cortical tumor, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus.[6] Polyuria may also be due to various chemical substances, such as diuretics, caffeine, and ethanol. It may also occur after supraventricular tachycardias, during an onset of atrial fibrillation, childbirth, and the removal of an obstruction within the urinary tract. Diuresis is controlled by antidiuretics such as vasopressin, angiotensin II and aldosterone. Cold diuresis is the occurrence of increased urine production on exposure to cold, which also partially explains immersion diuresis. High-altitude diuresis occurs at altitudes above 10,000 feet (3,000 m) and is a desirable indicator of adaptation to high altitudes. Mountaineers who are adapting well to high altitudes experience this type of diuresis. Persons who produce less urine even in the presence of adequate fluid intake are probably not adapting well to altitude.

Urinary tract infection (bacteria are black and bean-shaped)

List of causes
Emphysematous cystitis
Lithium-carbonate
General

Urinary system

Hormonal

Circulation

Neurologic

Other

Mechanism

Polyuria in osmotic cases, increases flow amount in the distal nephron where flow rates and velocity are low. The significant pressure increase occurring in the distal nephron takes place particularly in the cortical-collecting ducts. One study from 2008 lays out a hypothesis that hyperglycaemic and osmotic polyuria play roles ultimately in diabetic nephropathy.[39]

Diagnosis

Among the possible tests to diagnose polyuria are:[4]

Treatment

Depending on the cause of the polyuria, the adequate treatment should be afforded. According to NICE, desmopressin can be considered for nocturnal polyuria, which can be caused by diabetes mellitus,[5] if other medical treatments have failed. The recommendation had no studies that met the criteria for consideration.[40]

See also

References
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  2. Rudolf, Mary (2006). Paediatrics and Child Health (2nd ed.). Wiley. p. 142. ISBN 9781444320664. Retrieved 5 August 2015.
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  4. "Polyuria. Medical Professional reference for Polyuria. | Patient". Patient. Retrieved 2015-11-08.
  5. Merseburger, Axel S.; Kuczyk, Markus A.; Moul, Judd W. (2014-10-21). Urology at a Glance. Springer. ISBN 9783642548598.
  6. "Polyuria". Merck Manuals. November 2013. Retrieved 30 December 2014.
  7. "Definition of Diuresis". MedTerms. 30 October 2013. Retrieved 30 December 2014.
  8. "Diuresis". The Free Dictionary. Retrieved 30 December 2014.
  9. Parthasarathy, A. (2014-04-30). Case Scenarios in Pediatric and Adolescent Practice. JP Medical Ltd. ISBN 9789351520931.
  10. Ronco, Claudio (2009). Critical Care Nephrology (2nd ed.). Saunders. p. 475. ISBN 978-1416042525. Retrieved 5 August 2015.
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  39. Wang, Shinong; Mitu, Grace M.; Hirschberg, Raimund (2008-07-01). "Osmotic polyuria: an overlooked mechanism in diabetic nephropathy". Nephrology Dialysis Transplantation. 23 (7): 2167–2172. doi:10.1093/ndt/gfn115. ISSN 0931-0509. PMID 18456680.
  40. "Nocturia and nocturnal polyuria in men with lower urinary tract symptoms: oral desmopressin | key-points-from-the-evidence | Advice | NICE". www.nice.org.uk. Retrieved 2015-08-03.

Further reading
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