What are common and serious causes of polyuria?
As title thanks. I’m totally not comfortable with this topic.
I can think of UTI, interstitla cystitis, renal impairment, diabetes (mellitus and insipidus), drug effects, types of urinary incontinence off the top of my head.
I might start with MSU m/c/s and EUC. Move onto 24 hour urine, serum and urine osmolarity, EUC, CMP, glucose tolerance test, ADH, renal track U/S and urodynamics. Possibly finally try fluid deprivation and therapeutic trial of vasopressin.
What are some other common or serious causes I’m missing? How would you work up step by step someone with “polyuria of unknown origin”?
You first need to define polyuria. Polyuria is defined by the VOLUME of urine passed each day, not the frequency (this is relevant when thinking about infection, obstruction etc). And are you judging it by measuring the volume or just by the person’s estimate?
Then you need to deal with their fluid balance – how much is the person drinking – psychogenic polydipsia is a common cause, especially when people are wrongly told by the media that they have to drink liters of water every day. Or people think they have to have a cup of water for every cup of coffee, etc. Have they had IV fluids?
Then clinical status: are they oedematous or clinically dry? What is the blood pressure? What are the plasma and urine electrolytes? High plasma sodium/urea/osmolality are suggestive of water loss. Low sodium/urea/osmolality are more suggestive of water gain i.e. polydipsia. What medications are they on (diuretics?). Any history of head injury/stroke (diabetes insipidus). Do they have to get up in the night to pass urine or to quench their thirst – that can be a sign of an organic problem rather than psychogenic polyuria/polydipsia.
My area is biochemistry, so the main things I’d look for would be plain old polydipsia, medication history, plasma/urine glucose (glycosuria/osmotic diuresis), plasma calcium (hypercalcaemia/hyperparathyroidism etc), renal problems (plasma urea/creatinine, urine protein, serum and urine electrophoresis).
If no obvious cause is found and it’s hard to know whether it’s primary polydipsia or diabetes insipidus, perform a water deprivation test under close observation and with regular electrolytes/osmolality. (check the difference between osmolarity and osmoLALity!!). That was a good piece of revision for me! And by the way good luck finding a lab that will measure ADH
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