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PubMed1977

Dopamine-related polyuria in patients with gram-negative infection.

Two patients developed polyuria with natriuresis while receiving intravenous dopamine hydrochloride for the treatment of hypotension. Both patients had Gram-negative pneumonia and both had evidence of extracellular volume depletion that was considered to be a result of the dopamine-induced polyuria. Following restoration of extracellular volume and withdrawal of dopamine therapy, both patients became normotensive and required no vasopressors. The diuretic action of dopamine, which persisted despite the severe intravascular volume contraction and perpetuated the hypotensive state in these two patients, is not well understood. The Gram-negative infection could play an important role possibly by enhancing the effect of dopamine on the renal vasculature.

Aged↗
PubMedDate not supplied

[Drug-induced polyuria in the surgical treatment of patients with nephrolithiasis].

Recently, drug polyuria has found wide application in diagnosis and treatment: to detect latent urinary insufficiency, to assess functional performance of the contralateral (unaffected) kidney in nephrolithiasis and calculous pyelonephritis, to stimulate elimination of fragments of the disintegrated concrement, to check up suture impermeability after surgical repair of the urinary tracts, to outline afunctional zone in hydronephrosis. Clinical experience gives grounds for use of saluretics at certain stages of pyelolithotomy for mobilization of intrarenal pelvis and its dissection, removal of the calculus and subsequent suturing of the intrarenal pelvis. Therapeutic polyuria can also facilitate ureterolithotomy.

Combined Modality Therapy↗
PubMed1995

The nocturnal polyuria syndrome (NPS).

1. The nocturnal polyuria syndrome (NPS) is characterized by an increased nocturnal urine output. The diurnal rhythm in the antidiuretic hormone (ADH) system is absent, and often there is no detectable ADH in the plasma at all during the night. The 24-hr urine output is normal or only moderately increased. Men without nocturnal micturition, normally have a substantial increase in their nocturnal plasma ADH, while those with a need to micturate during the night have the same ADH level at night as in the daytime. Women have lower ADH levels than men, and no nocturnal increase in ADH irrespective of nocturnal voiding. Subjects with an increased nocturnal voiding frequency due to increased nocturnal urine output have an increased thirst, most markedly at night. They often avoid drinking in the evening, but they are unable to resist the impulse to drink during the night. People with polyuria at night wake up often because of the need to void, and accordingly are often tired during the day. 2. An increased nocturnal urine output can be reduced by administration of desmopressin at night. In a short-term study of elderly sufferers from NPS, treated with 20 micrograms desmopressin as nose drops in the evening the nocturnal urine output was reduced from 65 +/- 8% of the 24-hr urine output before treatment to 50 +/- 15% during treatment. In another study elderly with NPS were treated with 40 micrograms desmopressin as an intranasal aerosol in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Natriuretic Factor↗
PubMed1986

Study of hypotonic polyuria after trans-sphenoidal pituitary adenomectomy.

We have studied the postoperative diuresis patterns in 116 patients following the removal of a pituitary adenoma using the trans-sphenoidal approach. We observed a normal diuresis (ND) in 55 patients and a hypotonic polyuria (HP) in 61 patients, consisting of water elimination (WE = 45 cases) and transient diabetes insipidus (DI = 16 cases). We investigated the problem of predicting these patterns from eight pre-operative factors by applying stepwise logistic discriminant analysis. We demonstrated that DI was significantly associated with a posterior localization of the adenoma in the pituitary gland and that WE was more frequently observed in cases of suprasellar expansion, in young patients, and in prolactin secreting tumors. Finally, we discuss the pathogenic role of these factors in the occurrence of HP, taking into account inhibition of vasopressin secretion and possible fluid overload.

Adenoma↗
PubMed1985

[Mechanisms of postobstructive polyuria].

Postobstructive diuresis occurs after relief of bilateral ureteral obstruction despite the persistent decrease in renal cortical perfusion and glomerular filtration rate (GFR). After an initial transient rise in renal blood flow (RBF) during acute ureteral obstruction, tubular damage and progressive vasoconstriction with decreased RBF, especially of medullary perfusion, are observed with chronic obstruction. These are associated with an activation of the renin-angiotensin system and of renal prostaglandin (PG) synthesis with enhanced production of the vasoconstrictor thromboxane A2. Azotemia and extracellular fluid volume (ECFV) expansion result from impaired renal function. Mechanisms of polyuria following relief from bilateral chronic obstruction include enhanced PGE-mediated medullary blood flow, structural and functional tubular damage with decreased sodium reabsorption and (vasopressin-resistant) impaired renal concentrating ability, osmotic diuresis, activation of natriuretic factors following ECFV-expansion, and sometimes iatrogenic excessive fluid replacement. The resulting loss of fluid and electrolytes represents a major hazard in patients after surgical correction of congenital or acquired urinary tract obstruction.

Animals↗
PubMed2006

Nocturnal polyuria and nocturia relief in patients treated with solifenacin for overactive bladder symptoms.

The objectives of this study are to determine whether patients with overactive bladder (OAB) and nocturia achieved relief of their nighttime voiding symptoms when treated with solifenacin and whether having nocturnal polyuria (NP) affected that response. The patients pooled from four phase III clinical trials were evaluated for reductions in nocturia episodes after treatment with solifenacin (5 or 10 mg) or placebo. A second analysis was performed in patients with and without NP. The patients treated with solifenacin experienced statistically significant reductions in nocturia episodes; median reductions were -35.5% for 5 mg of solifenacin and -36.4% for 10 mg of solifenacin compared with -25.0% for placebo, and significantly more patients treated with solifenacin vs placebo achieved a mean nocturic frequency of <or=1 episode/night. Solifenacin significantly reduced nocturia episodes only in patients without NP (mean change was -0.61 episodes/night for both doses compared with -0.43 episodes for placebo). Solifenacin significantly improved nocturia symptoms only in OAB patients without NP.

Female↗
PubMed2000

Polyuria and proteinuria in cystinosis have no impact on renal transplantation. A report of the North American Pediatric Renal Transplant Cooperative Study.

Because cystinotic patients are polyuric and may have severe proteinuria, each of which is a potential risk factor for graft thrombosis, preemptive transplantation for them is questionable. The objectives of this study were to characterize the changes in urine volume and protein excretion at various stages of cystinosis, determine whether there is serologic evidence of hypercoagulability, and review the clinical experience in renal transplantation in cystinotic children. The records of cystinotic patients followed at the Montreal Children's Hospital between 1992 and 1998 were reviewed. Urinary volume, protein excretion, and coagulation markers were collected to determine the glomerular filtration rate (GFR) >50 ml/min/1.73 m2, <20 ml/min/1.73 m2, before and after starting dialysis. In addition, graft failure and graft thrombosis rates were obtained from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database. Urinary volume and protein excretion remained elevated throughout different phases of the disease. Coagulation factors were within normal limits for all patients. In the NAPRTCS database there were four thromboses among the 114 patients transplanted cystinotic patients. All these occurred in cadaveric grafts and only one occurred after preemptive transplantation. Despite polyuria and severe proteinuria, children with cystinosis do not appear to be at an increased risk of graft failure or graft thrombosis.

Child↗
PubMed1987

Polyuria and refractory hypernatremia after cardiopulmonary arrest.

A patient exhibited brain damage, polyuria, and refractory hypernatremia after myocardial infarction and cardiopulmonary arrest. Serum vasopressin levels were relatively fixed and inappropriately low for the elevated serum osmolality. Hypernatremia persisted despite administration of vasopressin; after vasopressin was discontinued, serum sodium value was corrected with small doses of furosemide and replacement of free water. In her case, impairment of osmotic homeostasis could not be attributed to either simple resetting or complete destruction of osmoreceptors; metabolic normalization required an unusual therapeutic approach.

Diabetes Insipidus↗
PubMedDate not supplied

Neonatal treatment with vasopressin antagonist dP[Tyr(Me)2]AVP, but not with vasopressin antagonist d(CH2)5[Tyr(Me)2]AVP, inhibits body and brain development and induces polyuria in the rat.

Two vasopressin antagonists, d(CH2)5[Tyr(Me)2]AVP and dP[Tyr(Me)2]AVP, were given to Wistar rats from postnatal day 1 to 21 in order to investigate the influence on development and later diuresis. The latter antagonist significantly reduced body growth from day 3 postnatally onwards. At postnatal day 35 body, total brain, cerebellar and kidney weights were significantly reduced compared with controls. Diuresis, measured at one month of age, was four- to five-fold higher than the control group. Combined treatment with vasopressin failed to abolish the weight disturbances or polyuria. However, animals treated with the vasopressin antagonist d(CH2)5[Tyr(Me)2]AVP did not show developmental or diuretic deficits. Allometric analysis of brain/body relationship of the young animals indicated a disturbance of brain development by dP[Tyr(Me)2]AVP. Although the body and brain growth retardation induced by dP[Tyr(Me)2]AVP supports the hypothesis of a role for vasopressin in brain ontogeny, it can also be the result of a nonAVP-related toxic effect, since it could not be prevented by concomitant treatment with vasopressin.

Animals↗
PubMed2006

Abnormal circadian rhythm of diuresis or nocturnal polyuria in a subgroup of children with enuresis and hypercalciuria is related to increased sodium retention during daytime.

PURPOSE: In a subgroup of children with enuresis an increase in nighttime water and solute excretion has been documented. To investigate if modifications in renal function are involved in nocturnal enuresis, we assessed circadian variation in natriuresis and tubular sodium handling in polyuric hypercalciuric children. MATERIALS AND METHODS: A total of 10 children with proved hypercalciuria and nocturnal polyuria and 10 age matched controls were included in the study. A 24-hour urine collection was performed in 8 sampling periods for measurement of urinary sodium excretion. Segmental tubular sodium transport was investigated during a daytime oral water load test and calculated according to standardized clearance methodology. RESULTS: The children with enuresis showed a marked increase in the fractional excretion of sodium during the night (0.93% +/- 0.36%), while daytime sodium excretion was decreased (0.84% +/- 0.23%). Analysis of segmental tubular sodium transport revealed decreased delivery of sodium to distal tubule (C(H2O) + C(Na) = 10.7 ml/100 ml glomerular filtration rate), indicating increased proximal tubular sodium reabsorption but also stimulation of distal sodium reabsorption as demonstrated by increased fractional distal sodium reabsorption (92.9% +/- 2.2%, controls 90.5% +/- 2.9%). Increased distal reabsorption was associated with increased fractional potassium excretion (17.5% +/- 2.7%, controls 13.6% +/- 6.4%), indicating increased distal tubular sodium/potassium exchange. CONCLUSIONS: No intrinsic defect in renal tubular sodium transport was found, but during the day increased sodium reabsorption in proximal and distal tubules was observed, suggesting extrarenal factors to be involved in altered circadian variation in solute and water excretion by the kidney.

Adolescent↗
PubMed2006

Nocturnal polyuria in patients with lower urinary tract symptoms and response to alpha-blocker therapy.

OBJECTIVES: To determine the prevalence of nocturnal polyuria (NP, defined as a nocturnal urine fraction exceeding one third of the daily urine output in elderly men) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and clinical responsiveness to alpha-blocker therapy. METHODS: Outpatients with LUTS suggestive of BPH were included. Patients filled out the International Prostate Symptom Score questionnaire and a 7-day voiding diary, and urinalysis, prostate-specific antigen measurement, uroflowmetry, and ultrasonography were performed. Patients with NP were given alpha-blocker therapy (tamsulosin 0.4 mg/day) for 6 weeks and then re-evaluated for NP and urinary symptoms. RESULTS: A total of 58 outpatients were included in the study. Of these, 95% had NP. The mean frequency of nocturia was 2.73 +/- 1.44 per day. A significant correlation was found between NP and the duration of LUTS (r = 0.393, P = 0.035) and the amount of water intake within 3 hours before sleep (r = 0.731, P = 0.001). Of the patients with NP, 20 were given alpha-blocker therapy. After therapy, the peak urinary flow rate had increased significantly, but NP remained unchanged in 75% of the patients. CONCLUSIONS: NP is a common symptom accompanying LUTS suggestive of BPH. Our results showed that it is significantly related to the duration of LUTS and amount of water intake before sleep. NP cannot be treated with alpha-blocker therapy, although there is improvement in LUTS suggestive of BPH.

Adrenergic alpha-Antagonists↗
PubMed1997

Nocturnal polyuria and antidiuretic hormone levels in spinal cord injury.

OBJECTIVE: To establish baseline ADH levels in spinal cord injury patients and to evaluate whether spinal cord patients have attenuation of diurnal variation of ADH similar to children with enuresis and elderly with nocturnal polyuria. DESIGN: Twenty-seven healthy quadriplegic patients, ASIA impairment scale A, were evaluated for serum ADH levels at night and during the day. MAIN OUTCOME MEASURES: Evaluation of whether bladder overdistention caused by attenuation of diurnal variation of ADH is responsible for the episodes of autonomic dysreflexia and recurrent urinary tract infections in spinal cord injury patients who are on intermittent catheterization for bladder management. RESULTS: A lack of diurnal variation of ADH in the subject population. CONCLUSIONS: A trial of desaminocystein-D-arginine vasopressin (DDAVP) should be considered for patients with established attenuation of the diurnal variation ADH.

Adult↗
PubMed1984

Correction of polyuria by activation of adenylate cyclase in Brattleboro rats.

The diterpene forskolin has been demonstrated to activate adenylate cyclase in many tissues, independently of receptors, guanyl nucleotides or the guanine nucleotide regulatory protein. Rats with hereditary hypothalamic diabetes insipidus (Brattleboro strain) have a defect in the synthesis of vasopressin. This absence of vasopressin is reflected by polyuria and a decrease in the urinary excretion of cyclic AMP, which mediates the action of vasopressin in the epithelial cells of the collecting ducts. Treatment of Brattleboro rats or of control Long-Evans rats with forskolin in doses as low as 7 micrograms/animal produced a significant decrease in urine volume. The reduction in urinary volume was associated with a significant increase in the cyclic AMP content of renal medullary tissue. Thus, systemic activation of adenylate cyclase can correct the pathophysiological consequences of the absence of vasopressin.

Adenylyl Cyclases↗
PubMed2002

Hyponatremia associated with desmopressin for the treatment of nocturnal polyuria.

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the mammalian arginine vasopressin used in the treatment of central diabetes insipidus, bleeding disorders, and incontinence. The primary adverse reaction associated with DDAVP is hypotonic hyponatremia. Hyponatremia has been reported in adults treated with DDAVP for Von Willebrand's disease and hemophilia and in children treated for enuresis, but as yet few cases of hyponatremia developing in enuretic adults treated with DDAVP have been reported. We report the cases of two elderly women taking DDAVP for nocturnal polyuria who developed severe hyponatremia. One patient died in the hospital.

Aged↗
PubMed2002

Nocturnal polyuria versus overactive bladder in nocturia.

The purpose of this article is to review the current state of knowledge on contributions of nocturnal urine overproduction and overactive bladder to the syndrome of nocturia. We review the recent literature and current state of the art in differential diagnosis, pathophysiology, and classification of nocturia. We found that multiple pathologic factors may result in nocturia, including cardiovascular disease, diabetes mellitus or insipidus, third spacing of fluid, sleep apnea, lower urinary tract obstruction, primary sleep disorders, and behavioral and environmental factors. Thus, nocturia may be attributed to nocturnal polyuria (nocturnal urine overproduction), diminished nocturnal bladder capacity, or both. Distinction between these conditions is made by a simple arithmetic analysis of the 24-hour voiding diary. Understanding the manifold origins of nocturia will lead to rational treatment of specific contributing pathophysiologic factors.

Aged↗
PubMed1989

Diagnostic approach to polydipsia and polyuria.

A variety of metabolic disturbances account for the majority of cases of polydipsia and polyuria. This chapter presents guides to differential diagnosis as well as a discussion of the etiology and clinical features of the primary causes--central diabetes insipidus, nephrogenic diabetes insipidus, and psychogenic polydipsia.

Animals↗
PubMed1999

Subclinical polydipsia and polyuria in young patients with schizophrenia or obsessive-compulsive disorder vs normal controls.

1. Increased water intake and output is more common among psychiatric patients, especially those with schizophrenia, than in the general population. Animal studies suggest that polydipsia and polyuria derive, in part, from dopamine dysregulation. Stimulated by these observations this study sought to elucidate relationships among water homeostasis, monoamine metabolism, and electrolyte excretion in schizophrenic patients with and without paranoid hallucinatory symptoms (PH vs. NP), thought to reflect hyper- and hypo-dopaminergic states respectively, and to compare these with those shown by patients with obsessive compulsive disorder (OCD). 2. 24 hr-urine samples for electrolyte, monoamine and metabolite measures were taken from 14 schizophrenic patients with PH symptoms, 13 with predominantly nonparanoid (NP) symptoms, 11 OCD patients and 27 healthy controls (matched for age, weight and creatinine production). Water intake and serum electrolytes was sampled during psychological testing. 3. PH patients drank 2-3 times more than the others in a 3-4 hr test, yet 24 hr-urinary volumes were 75% larger in both PH and NP patients than in the two comparison groups. 4. Daily potassium excretion was a bit higher in PH patients, but concentrations of sodium, potassium and phosphate tended to be lower in PH and NP patients than in the others. 5. Positive associations of electrolyte with homovanillic acid excretion were consistent across groups and not directly related to medication. But associations of electrolyte excretion with noradrenergic activity in controls were absent in psychotic patients and associations with serotonin in OCD patients were absent in the other groups. 6. Increased water intake and output in PH patients along with the disturbed association with noradrenergic metabolism are consistent with altered autonomic activity in these patients. 7. The independence of measures of water homeostasis from dopaminergic medication indicates that the associations in clinically responding PH patients of polydipsia with DA function (decreased DA levels) may be pertinent to this subgroup but not to schizophrenia in general.

Adolescent↗
PubMed2001

The approach to a patient with acute polyuria and hypernatremia: a need for the physiology of McCance at the bedside.

We present a case to illustrate the importance of emphasizing elementary physiology to deduce the basis for the acute onset of polyuria and hypernatremia. An imaginary consultation with Professor McCance is utilized to illustrate how a clinician-physiologist would have explained why these abnormalities developed and how they should have been treated. His approach began with a consideration of the most impressive abnormality. His analysis relied heavily on deductions and the anticipation of the expected responses to a stimulus in quantitative terms. The goals of therapy became evident after he performed mass balance calculations. Professor McCance would not understand why modern clinicians abandoned this form of analysis.

Adult↗