Polyuria

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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

Common Causes

• Benign prostate hyperplasia 
• 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 

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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Differential Diagnosis of Polyuria

In alphabetical order.

• Acromegaly
• Addison's disease
• Alcohol
• BCG vaccine
• Behavioral or psychogenic water drinking
• Caffeine
• Chemotherapeutic agents
• Cidofovir
• Congestive heart failure
• Cushing's syndrome
• Cystitis
• Diabetes insipidus
• Diabetes mellitus
• Diuretics
• Emphysematous cystitis
• Enlarged prostate from disease or benign prostatic hyperplasia
• Fanconi syndrome/renal glycosuria
• Glomerulonephritis
• high doses of riboflavin
• Hyperaldosteronism/Conn's syndrome
• Hypercalcaemia
• Hypercalcemia (most commonly from cancer)
• Hyperthyroidism
• Hypokalemia
• hypopituitarism
• Interstitial cystitis
• Interstitial nephritis
• Intestinal obstruction (occurs after toxins begin to be absorbed from the damaged intestine)
• Liver failure/ cirrhosis
• Lupus or other connective tissue disease related cystitis
• Neurologic damage
• Partial obstruction of the urinary tract
• Pheochromocytoma
• Polycythemia
• Pregnancy
• Pyometra in certain animals or appendicitis in humans
• Reactive arthritis/Reiter's syndrome
• Renal Tubular Acidosis
• SIADH
• Side effect of lithium to treat manic disorders see lithium thirst
• Sjogren's Syndrome
• Squamous cell carcinoma of lung (a paraneoplastic consequence)
• Tenofovir disoproxil fumarate
• Urinary tract infection - although it more commonly causes frequent passage of small volumes of urine rather than a large volume

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

POLYURIA

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	–	–	–	–	–	–	Normal	Normal	Low	Improves urine osmolarity	No improvement	Increased thirst
Increased solute excretion	Osmotic causes	Diabetes mellitus	–	±	–	–	–	Late stage	High in Type 2	Normal	Normal	No effect	No effect	Hyperosmolar hyperglycemic state
	Salt loss	Diuretics	–	+	–	+	–	±	Normal	Raised	Normal, increased with thiazides	No effect	No effect
		Cerebral salt-wasting syndrome	–	–	–	–	–	–	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	±	±	–	–	±	+	Increased
		Bartter syndrome
Miscellaneous		Benign Prostatic Hyperplasia (BPH)	+	+	+	+	±	–	Normal

References

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