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

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. [1] [2]

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


POLYURIA[3]

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[4] – – – – – – Normal Normal Low Improves urine osmolarity No improvement Increased thirst
Increased solute excretion Osmotic causes Diabetes mellitus[5] – ± – – – Late stage High in Type 2 Normal Normal No effect No effect Hyperosmolar hyperglycemic state
Salt loss Diuretics – + – + – ± Normal Raised[6] Normal, increased with thiazides[7] No effect No effect
Cerebral salt-wasting syndrome[8] – – – – – – 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[9] ± ±[10] – – ± + Increased
Bartter syndrome
Miscellaneous Benign Prostatic Hyperplasia (BPH)[11] + + + + ± – Normal

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. ↑ 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.
  4. ↑ Mellinger RC, Zafar MS (1983). "Primary polydipsia. Syndrome of inappropriate thirst". Arch Intern Med. 143 (6): 1249–51. PMID 6860053.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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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