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==Overview==
==Overview==


'''Polyuria''' is the passage of a large volume of [[urine]] in a given period (>= 2.5L/24 hours in adult humans) [http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm]  It often appears with increased thrist ([[polydipsia]]), though it is possible to have one without the other.
'''[[Polyuria]]''' is the passage of a large volume of [[urine]] in a given period (>= 2.5L/24 hours in adult humans) [http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm]  It often appears with increased thrist ([[polydipsia]]), though it is possible to have one without the other.


==Causes==
==Causes==
<div style="-webkit-user-select: none;">
# [[Central diabetes inspidous]]
===Common Causes===
## [[Idiopathic CDI]]: the most common cause of CDI<ref name="1">Kimmel DW, O'Neill BP: Systemic cancer presenting as diabetes insipidus. Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus. Cancer 1983, 52(12):2355-2358.</ref><ref>Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S, Tinelli C, Gallucci M, Bernasconi S, Boscherini B et al: Central diabetes insipidus in children and young adults. The New England journal of medicine 2000, 343(14):998-1007.</ref>
*[[Benign prostate hyperplasia ]]
## [[Familial CDI]]<ref>Christensen JH, Rittig S: Familial neurohypophyseal diabetes insipidus--an update. Seminars in nephrology 2006, 26(3):209-223.</ref>
*[[Bladder cancer ]]
## [[Wolfram syndrome]] ( [[DIDOMAD syndrome]])<ref>Bischoff AN, Reiersen AM, Buttlaire A, Al-Lozi A, Doty T, Marshall BA, Hershey T: Selective cognitive and psychiatric manifestations in Wolfram Syndrome. Orphanet journal of rare diseases 2015, 10:66.</ref>
*[[Bladder compression ]]
## Congenital [[hypopituitarism]]<ref>Lukezic M, Righini V, Di Natale B, De Angelis R, Norbiato G, Bevilacqua M, Chiumello G: Vasopressin and thirst in patients with posterior pituitary ectopia and hypopituitarism. Clinical endocrinology 2000, 53(1):77-83.</ref>
*[[Bladder conditions]]
## [[Septo-optic dysplasia]]<ref>Hoyt WF, Kaplan SL, Grumbach MM, Glaser JS: Septo-optic dysplasia and pituitary dwarfism. Lancet (London, England) 1970, 1(7652):893-894.</ref>
*[[Bladder diverticulum]]
## [[Surgery]]/[[trauma]]<ref>Nemergut EC, Zuo Z, Jane JA, Jr., Laws ER, Jr.: Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. Journal of neurosurgery 2005, 103(3):448-454.</ref>
*[[Enlarged prostate ]]
## [[Cancer]] (lung cancer, leukemia, lymphoma)<ref name="1">Kimmel DW, O'Neill BP: Systemic cancer presenting as diabetes insipidus. Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus. Cancer 1983, 52(12):2355-2358.</ref>
*[[Noctural polyuria syndrome]]
## [[Hypoxic encephalopathy]]<ref>Wickramasinghe LS, Chazan BI, Mandal AR, Baylis PH, Russell I: Cranial diabetes insipidus after upper gastrointestinal hemorrhage. British medical journal (Clinical research ed) 1988, 296(6627):969.</ref>
*[[Overactive bladder]]
## Infiltrative disorders ( [[histiocytosis X]], [[sarcoidosis]], [[granulomatosis with polyangiitis]])<ref>Dunger DB, Broadbent V, Yeoman E, Seckl JR, Lightman SL, Grant DB, Pritchard J: The frequency and natural history of diabetes insipidus in children with Langerhans-cell histiocytosis. The New England journal of medicine 1989, 321(17):1157-1162.</ref><ref>Garovic VD, Clarke BL, Chilson TS, Specks U: Diabetes insipidus and anterior pituitary insufficiency as presenting features of Wegener's granulomatosis. American journal of kidney diseases : the official journal of the National Kidney Foundation 2001, 37(1):E5.</ref>
*[[Pathological water intake]]
## Post-supraventricular tachycardia<ref>Canepa-Anson R, Williams M, Marshall J, Mitsuoka T, Lightman S, Sutton R: Mechanism of polyuria and natriuresis in atrioventricular nodal tachycardia. British medical journal (Clinical research ed) 1984, 289(6449):866-868.</ref><ref>Fujii T, Kojima S, Imanishi M, Ohe T, Omae T: Different mechanisms of polyuria and natriuresis associated with paroxysmal supraventricular tachycardia. The American journal of cardiology 1991, 68(4):343-348.</ref>
*[[Postobstructive uropathy]]
## [[Anorexia nervosa]]<ref>Gold PW, Kaye W, Robertson GL, Ebert M: Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa. The New England journal of medicine 1983, 308(19):1117-1123.</ref>
*[[Prostate cancer]]
*[[Prostate conditions ]]
*[[Sassoon hospital syndrome]]
*[[Serratia urinary tract infection ]]
*[[Urethral cancer ]]
*[[Urethritis ]]
*[[Urinary outflow obstruction ]]
*[[Urinary stones ]]
*[[Urinary tract infection]]
*[[Uterine fibroids ]]
*[[Uterine leiomyoma ]]


===Causes by Organ System===
===Causes by Organ System===

Revision as of 22:32, 5 June 2018

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Resident
Survival
Guide
Polyuria
ICD-10 R35
ICD-9 788.42

Template:Search infobox Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753;

To view a comprehensive algorithm of common findings of urine composition and urine output, click here
Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Polyuria is the passage of a large volume of urine in a given period (>= 2.5L/24 hours in adult humans) [2] It often appears with increased thrist (polydipsia), though it is possible to have one without the other.

Causes

  1. Central diabetes inspidous
    1. Idiopathic CDI: the most common cause of CDI[1]
    2. Familial CDI[2]
    3. Wolfram syndrome ( DIDOMAD syndrome)[3]
    4. Congenital hypopituitarism[4]
    5. Septo-optic dysplasia[5]
    6. Surgery/trauma[6]
    7. Cancer (lung cancer, leukemia, lymphoma)
    8. Hypoxic encephalopathy[7]
    9. Infiltrative disorders ( histiocytosis X, sarcoidosis, granulomatosis with polyangiitis)[8][9]
    10. Post-supraventricular tachycardia[10][11]
    11. Anorexia nervosa[12]

Causes by Organ System

Cardiovascular Cardiorespiratory disease, Circulation, Congestive heart failure, Paroxysmal tachycardia
Chemical/Poisoning 3,3-dichlorobenzidine  , Caffeine poisoning, Foscarnet sodium, Frusemide, Juniper tar poisoning  , Oak poisoning  , Silicon dioxide, Sodium ferrocyanide, Sorbitol
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amitraz  , Bcg vaccine, Bendrofluazide, Bumetanide, Canagliflozin, Conivaptan, Dapagliflozin, Diuretic therapy, Empagliflozin, Goserelin, Hydrochlorothiazide, Isosorbide, Lithium, Mannitol, Nabilone, Phendimetrazine, Probenecid, Tiagabine, Tolvaptan, Use of a corticosteroid 
Ear Nose Throat Sicca syndrome
Endocrine Adrenal adenoma, Adrenal cancer, Adrenal cortex neoplasms  , Adrenal gland hyperfunction  , Aldosteronism, Conn's disease  , Cushing syndrome, Cystinosis  , Dka, Ectopic acth syndrome  , Electrolyte abnormality  , Familial hypopituitarism  , Fanconi syndrome, Froelich's syndrome  , Hair-an syndrome  , Hormonal, Hyperadrenalism  , Hypercalcemia, Hypercalcuria  , Hyperglycemia  , Hyperosmolar hyperglycemic nonketotic syndrome  , Hyperparathyroidism, Hyperthyroidism, Hypokalemia, Hypokalemic periodic paralysis  , Hypopituitarism, Hypothalamic dysfunction  , Intermediate cystinosis  , Multiple endocrine neoplasia  , Panhypopituitarism  , Parathyroid cancer, Pheochromocytoma, Pituitary tumors, Polydipsia, Postural orthostatic tachycardia syndrome, Primary hyperaldosteronism  , Syndrome of inappropriate antidiuretic hormone
Environmental Postobstructive uropathy
Gastroenterologic Gestational diabetes, Rib tumor  , Wandering spleen 
Genetic Aceruloplasminemia  , Amelogenesis imperfeca, Apparent mineralocorticoid excess  , Bartter syndrome  , Boichis syndrome  , Conn's disease  , Dend syndrome  , East syndrome  , Gitelman syndrome  , Hair-an syndrome  , Hereditary primary fanconi disease  , Machado-joseph disease  , Senior-loken syndrome  , Wolfram's disease 
Hematologic Diabetes insipidus  , Diabetes mellitus, Excessive riboflavin, Excessive vitamin d, Hemochromatosis  , Hhns, Hypercalcemia, Hypercalcuria  , Hyperglycemia  , Hyperosmolar hyperglycemic nonketotic syndrome  , Hypervitaminosis a, Hypervitaminosis d, Hypokalemia, Hypokalemic periodic paralysis  , Langerhans cell histiocytosis  , Leukemia, Neurosarcoidosis  , Proximal renal tubular acidosis  , Resolving hematoma, Sickle-cell anemia
Iatrogenic Bcg vaccine, Chemotherapy-induced cystitis, Diuretic therapy, Pelvic lipomatosis  , Radiation cystitis, Radiographic contrast media
Infectious Disease Gonococcal urethritis  , Serratia urinary tract infection  , Streptococcal group b invasive disease  , Urinary tract infection
Musculoskeletal/Orthopedic Back tumor  , Hip cancer  , Pyelonephritis, Secondary bone cancer 
Neurologic Adrenocortical carcinoma  , Anorexia nervosa  , Cerebral salt-wasting syndrome, Diencephalic syndrome  , Migraine, Neurologic damage, Neurosarcoidosis  , Olivopontocerebellar atrophy type 3  , Postural orthostatic tachycardia syndrome, Psychogenic polydipsia, Seizures
Nutritional/Metabolic Aceruloplasminemia  , Dend syndrome  , Diabetes insipidus  , Diabetes mellitus, Diabetic nephropathy  , Excessive riboflavin, Excessive vitamin d, Gestational diabetes, Hhns, Hypervitaminosis a, Hypervitaminosis d, Nephrogenic diabetes insipidus  , Renal tubular transport disorders, Renal tubulopathy
Obstetric/Gynecologic Ovarian cysts  , Premenstrual syndrome  , Vagina cancer 
Oncologic Adrenal adenoma, Adrenal cancer, Adrenal cortex neoplasms  , Adrenal incidentaloma  , Adrenocortical carcinoma  , Back tumor  , Bladder cancer  , Chemotherapy-induced cystitis, Conn-louis carcinoma  , Conn's adenoma  , Ectopic acth syndrome  , Erdheim-chester disease  , Hip cancer  , Leukemia, Parathyroid cancer, Pituitary tumors, Prostate cancer, Prostate conditions  , Renal cell cancer  , Rib tumor  , Secondary bone cancer  , Urethral cancer  , Uterine leiomyoma  , Vagina cancer 
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anorexia nervosa  , Combat stress reaction  , Generalized anxiety disorder, Seizures
Pulmonary Cardiorespiratory disease, East syndrome  , Heerfordt syndrome 
Renal/Electrolyte Acid-base imbalance, Acute tubular necrosis, Aldosteronism, Alsing syndrome  , Altitude diuresis, Apparent mineralocorticoid excess  , Bartter syndrome  , Boichis syndrome  , Cerebral salt-wasting syndrome, Chronic glomerulonephritis, Chronic interstitial nephritis, Chronic kidney disease  , Chronic renal failure, Chronic wasting disease , Cystitis  , Danubian endemic familial nephropathy, Diabetic nephropathy  , Early chronic pyelonephritis, Electrolyte abnormality  , Eosinophilic cystitis, Gitelman syndrome  , Glomerulonephritis  , Interstitial cystitis, Juvenile nephronophthisis  , Medullary cystic kidney disease  , Megalocytic interstitial nephritis  , Membranoproliferative glomerulonephritis , Nephrocalcinosis  , Nephrogenic diabetes insipidus  , Nephrolithiasis , Nephronophthisis, Nephropathic cystinosis  , Oligomeganephronic renal hypoplasia  , Osmotic diuresis, Polycystic kidney disease  , Polydipsia, Primary tubular proximal acidosis  , Proximal renal tubular acidosis  , Proximal tubulopathy, Psychogenic polydipsia, Pyelonephritis, Radiation cystitis, Reflux nephropathy  , Renal cell cancer  , Renal failure, Renal tubular acidosis, Renal tubular transport disorders, Renal tubulopathy , Toni-fanconi syndrome type 1 
Rheumatology/Immunology/Allergy Heerfordt syndrome  , Neurosarcoidosis  , Reiter’s syndrome  , Uterine fibroids 
Sexual No underlying causes
Trauma No underlying causes
Urologic Benign prostate hyperplasia  , Benign prostate hypertrophy, Bladder cancer  , Bladder compression , Bladder conditions, Bladder diverticulum, Enlarged prostate  , Noctural polyuria syndrome, Overactive bladder, Pathological water intake, Postobstructive uropathy, Prostate cancer, Prostate conditions  , Sassoon hospital syndrome, Serratia urinary tract infection  , Urethral cancer  , Urethritis  , Urinary outflow obstruction  , Urinary stones  , Urinary tract infection, Uterine fibroids  , Uterine leiomyoma 
Miscellaneous No underlying causes

Causes in Alphabetical Order

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3

Differential Diagnosis of Polyuria

In alphabetical order. [13] [14]

Abbreviations: Na= Natrium/ Sodium, ADH= Antidiuretic hormone


POLYURIA[15]

Mechanism Etiology Clinical manifestations Paraclinical findings Comments
Symptoms and signs Lab findings/Urine exam
Dysuria Nocturia Hesitancy Dribbling Hematuria Proteinuria Serum osmolarity S. ADH Urine osmolarity Water deprivation test ADH administration
Increased intake of fluid Psychogenic polydipsia[16] – – – – – – Normal Normal Low Improves urine osmolarity No improvement Increased thirst
Increased solute excretion Osmotic causes Diabetes mellitus[17] – ± – – – Late stage High in Type 2 Normal Normal No effect No effect Hyperosmolar hyperglycemic state
Salt loss Diuretics – + – + – ± Normal Raised[18] Normal, increased with thiazides[19] No effect No effect
Cerebral salt-wasting syndrome[20] – – – – – – Normal Normal Low Improves urine osmolarity No effect
Impaired urinary concentration Low ADH Central diabetes insipidus – + – – ± ± Increased Low Low No improvement Urine osmolarity improves
Nephrogenic diabetes insipidus – + – – ± ± Increased Normal Low No improvement No improvement
Renal disease Renal tubular acidosis[21] ± ±[22] – – ± + Increased
Bartter syndrome
Miscellaneous Benign Prostatic Hyperplasia (BPH)[23] + + + + ± – Normal

References

  1. ↑ Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S, Tinelli C, Gallucci M, Bernasconi S, Boscherini B et al: Central diabetes insipidus in children and young adults. The New England journal of medicine 2000, 343(14):998-1007.
  2. ↑ Christensen JH, Rittig S: Familial neurohypophyseal diabetes insipidus--an update. Seminars in nephrology 2006, 26(3):209-223.
  3. ↑ Bischoff AN, Reiersen AM, Buttlaire A, Al-Lozi A, Doty T, Marshall BA, Hershey T: Selective cognitive and psychiatric manifestations in Wolfram Syndrome. Orphanet journal of rare diseases 2015, 10:66.
  4. ↑ Lukezic M, Righini V, Di Natale B, De Angelis R, Norbiato G, Bevilacqua M, Chiumello G: Vasopressin and thirst in patients with posterior pituitary ectopia and hypopituitarism. Clinical endocrinology 2000, 53(1):77-83.
  5. ↑ Hoyt WF, Kaplan SL, Grumbach MM, Glaser JS: Septo-optic dysplasia and pituitary dwarfism. Lancet (London, England) 1970, 1(7652):893-894.
  6. ↑ Nemergut EC, Zuo Z, Jane JA, Jr., Laws ER, Jr.: Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. Journal of neurosurgery 2005, 103(3):448-454.
  7. ↑ Wickramasinghe LS, Chazan BI, Mandal AR, Baylis PH, Russell I: Cranial diabetes insipidus after upper gastrointestinal hemorrhage. British medical journal (Clinical research ed) 1988, 296(6627):969.
  8. ↑ Dunger DB, Broadbent V, Yeoman E, Seckl JR, Lightman SL, Grant DB, Pritchard J: The frequency and natural history of diabetes insipidus in children with Langerhans-cell histiocytosis. The New England journal of medicine 1989, 321(17):1157-1162.
  9. ↑ Garovic VD, Clarke BL, Chilson TS, Specks U: Diabetes insipidus and anterior pituitary insufficiency as presenting features of Wegener's granulomatosis. American journal of kidney diseases : the official journal of the National Kidney Foundation 2001, 37(1):E5.
  10. ↑ Canepa-Anson R, Williams M, Marshall J, Mitsuoka T, Lightman S, Sutton R: Mechanism of polyuria and natriuresis in atrioventricular nodal tachycardia. British medical journal (Clinical research ed) 1984, 289(6449):866-868.
  11. ↑ Fujii T, Kojima S, Imanishi M, Ohe T, Omae T: Different mechanisms of polyuria and natriuresis associated with paroxysmal supraventricular tachycardia. The American journal of cardiology 1991, 68(4):343-348.
  12. ↑ Gold PW, Kaye W, Robertson GL, Ebert M: Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa. The New England journal of medicine 1983, 308(19):1117-1123.
  13. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  14. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  15. ↑ Bhasin, Bhavna; Velez, Juan Carlos Q. (2016). "Evaluation of Polyuria: The Roles of Solute Loading and Water Diuresis". American Journal of Kidney Diseases. 67 (3): 507–511. doi:10.1053/j.ajkd.2015.10.021. ISSN 0272-6386.
  16. ↑ Mellinger RC, Zafar MS (1983). "Primary polydipsia. Syndrome of inappropriate thirst". Arch Intern Med. 143 (6): 1249–51. PMID 6860053.
  17. ↑ Ahloulay M, Schmitt F, Déchaux M, Bankir L (1999). "Vasopressin and urinary concentrating activity in diabetes mellitus". Diabetes Metab. 25 (3): 213–22. PMID 10499190.
  18. ↑ Hwang KS, Kim GH (2010). "Thiazide-induced hyponatremia". Electrolyte Blood Press. 8 (1): 51–7. doi:10.5049/EBP.2010.8.1.51. PMC 3041494. PMID 21468197.
  19. ↑ Loffing, J. (2004). "Paradoxical Antidiuretic Effect of Thiazides in Diabetes Insipidus: Another Piece in the Puzzle". Journal of the American Society of Nephrology. 15 (11): 2948–2950. doi:10.1097/01.ASN.0000146568.82353.04. ISSN 1046-6673.
  20. ↑ Ozdemir H, Aycan Z, Degerliyurt A, Metin A (2010). "The treatment of cerebral salt wasting with fludrocortisone in a child with lissencephaly". Turk Neurosurg. 20 (1): 100–2. PMID 20066633.
  21. ↑ Pereira PC, Miranda DM, Oliveira EA, Silva AC (2009). "Molecular pathophysiology of renal tubular acidosis". Curr Genomics. 10 (1): 51–9. doi:10.2174/138920209787581262. PMC 2699831. PMID 19721811.
  22. ↑ Ranawaka R, Dayasiri K, Gamage M (2017). "A child with distal (type 1) renal tubular acidosis presenting with progressive gross motor developmental regression and acute paralysis". BMC Res Notes. 10 (1): 618. doi:10.1186/s13104-017-2949-2. PMC 5702097. PMID 29178965.
  23. ↑ Yoong HF, Sundaram MB, Aida Z (2005). "Prevalence of nocturnal polyuria in patients with benign prostatic hyperplasia". Med J Malaysia. 60 (3): 294–6. PMID 16379182.


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