Glycosuria

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Template:SignSymptom infobox

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Glycosuria or glucosuria is an abnormal condition of osmotic diuresis due to excretion of glucose by the kidneys.

The most common cause of glycosuria is untreated diabetes mellitus. The condition occurs when plasma glucose levels rise above kidney threshold for glucose reabsorption. At this point, the excess plasma glucose will not be reabsorbed in the proximal tubule and is excreted in the urine. When the excess glucose is excreted in the urine, it makes water enter the urine due to high osmolarity of the urine. This leads to the characteristic symptom of high urine volumes.

Glycosuria can be either a physiologic response of the body to elevated blood glucose levels, such as alimentary glycosuria; or it can be a pathologic phenomenon.

When glycosuria occurs at normal plasma glucose concentrations due to decreased renal threshold for glucose reabsorption, it is reffered to as renal glycosuria.

Glycosuria has been targeted as a therapeutic option for diseases such as diabetes mellitus, as induction of glycosuria leads to better glycemic control and decreases risk of cardiovascular diseases in diabetic patients.

Causes

Drugs Causing Glycosuria

Other chemicals causing glycosuria

Historical Perspective

Glycosuria was first discovered by von Mering and Minkowski in 1889.

Classification

Glycosuria can be classified into the following groups, based on the etiology of glucose excretion in urine:

Alimentary glycosuria
Renal Glycosuria
Diabetic glycosuria
Iatrogenic glycosuria

Pathophysiology

The pathogenesis of glycosuria is characterized by either increased plasma glucose or decreased proximal tubule threshold for glucose excretion.
Genetic mutations can contribute to pathogenesis in glycosuria, especially renal glycosuria, these mutations include: SLC5A2 and HNF1A^[1].
When plasma glucose levels exceed 180 mg/mL, the excess glucose will not be reabsorbed and is excreted in urine. However, proximal tubule threshold for glucose reabsorbtion varies among individuals and in difference stages of one's life span.

Clinical Features

Simultaneous excretion of glucose and water into urine leads to:

Differentiating [disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

[Differential dx1]
[Differential dx2]
[Differential dx3]

Epidemiology and Demographics

The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

Patients of all age groups may develop [disease name].

[Disease name] is more commonly observed among patients aged [age range] years old.
[Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

[Disease name] affects men and women equally.

[Gender 1] are more commonly affected with [disease name] than [gender 2].
The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

There is no racial predilection for [disease name].

[Disease name] usually affects individuals of the [race 1] race.
[Race 2] individuals are less likely to develop [disease name].

Risk Factors

Genetic predisposition
diabetes mellitus
exposure to medications or chemicals causing glycosuria

Natural History, Complications and Prognosis

Early clinical features include polyuria, polydipsia, hypoglycemia and weight loss due to excretion of glucose as a source of energy.
Common complications of glycosuria include polyuria, polydipsia, and mild growth retardation.
Glycosuria increases as the patients age due to decreased renal threshold for glucose excretion^[2].
Prognosis is generally excellent. There are no reports of mortality directly attributed to glycosuria.

Diagnosis

Diagnostic Criteria

Diagnosis of glycosuria depends on the type of glycosuria:

For renal glycosuria^[2]:

glycosuria in the face of normal blood glucose levels, normal glycosylated hemoglobin and normal free fatty acids
glycosuria independent of carbohydrate consumption
no diabetic symptoms

For Alimentary glycosuria^[2]:

normal fasting blood sugar
normal 2-hours post-prandial blood glucose
maximum blood glucose levels exceeding 180 mg/mL

Diabetic glycosuria:

glycosuria in the setting of known diabeties mellitus

Symptoms

Symptoms of glycosuriamay include the following:

polyuria
polydipsia
weight loss

Physical Examination

Patients with glycosuria generally appear normal in physical examination.

In specific conditions, such as pregnancy or starvation, patients may:

appear dehydrated
have ketosis

Laboratory Findings

There are no specific laboratory findings associated with [disease name].

A [positive/negative] [test name] is diagnostic of [disease name].
An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

There are no [imaging study] findings associated with [disease name].

[Imaging study 1] is the imaging modality of choice for [disease name].
On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

[Disease name] may also be diagnosed using [diagnostic study name].
Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
[Medical therapy 1] acts by [mechanism of action 1].
Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

Surgery is the mainstay of therapy for [disease name].
[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

There are no primary preventive measures available for [disease name].

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].