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Current Urology Reports Sep 2015Nocturia is a very common yet a highly underreported entity. Recently, there has been an increasing interest in nocturia because of its association with serious adverse... (Review)
Review
Nocturia is a very common yet a highly underreported entity. Recently, there has been an increasing interest in nocturia because of its association with serious adverse health conditions such as diabetes, heart disease, elevated BMI, and mortality. Frequency volume charts are the cornerstone of initial assessment and are pivotal in determining the type of nocturia and associated causes. The diagnostic evaluation is aimed at clarifying the underlying cause: sleep disturbances, reduced bladder capacity (functional or extrinsic), and increased urine production (nocturnal or daily). Obstructive sleep apnea is an important cause of nocturnal polyuria and should always been considered. Management is focused on treating the underlying cause; a range of behavioral and pharmacologic options are available.
Topics: Animals; Humans; Nocturia; Polyuria; Risk Factors; Sleep Apnea, Obstructive; Urodynamics
PubMed: 26231263
DOI: 10.1007/s11934-015-0533-7 -
Handbook of Clinical Neurology 2021Nocturnal enuresis is the involuntary pass of urine during sleep beyond the age of 5 years. It is a common condition in childhood and has an impact on the child's... (Review)
Review
Nocturnal enuresis is the involuntary pass of urine during sleep beyond the age of 5 years. It is a common condition in childhood and has an impact on the child's well-being. Research into the pathophysiology of the condition in the last decades has led to a paradigm shift, and enuresis is no longer considered a psychiatric disorder but rather a maturation defect with a somatic background. An excess urine production during sleep is a common finding in children with enuresis and disturbances in the circadian rhythm of arginine-vasopressin (AVP) is found in the majority of children with nocturnal polyuria. Children with enuresis and nocturnal polyuria lack the physiologic increase in AVP levels during sleep and treatment with the AVP analogue desmopressin can restore this rhythm and lead to dry nights. The reasons for this aberrant circadian AVP rhythm are not established. Furthermore, not all children with enuresis and nocturnal polyuria can be successfully treated with desmopressin suggesting that factors beyond renal water handling can be implicated such as natriuresis, hypercalciuria, and sleep-disordered breathing. The advances in the research of the genetic background of the condition may shed further light on the enuresis pathophysiology.
Topics: Arginine; Arginine Vasopressin; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis; Polyuria; Vasopressins
PubMed: 34238464
DOI: 10.1016/B978-0-12-820683-6.00021-X -
Current Opinion in Urology Jul 2014To review the published literature within the last 18 months that comment on the causes of nocturia, varying with age. The causes are categorized into organized subsets:... (Review)
Review
PURPOSE OF REVIEW
To review the published literature within the last 18 months that comment on the causes of nocturia, varying with age. The causes are categorized into organized subsets: nocturnal polyuria, storage or reduced bladder capacity, 24-h polyuria, and sleep-associated nocturia.
RECENT FINDINGS
Prevalence of nocturia is high, but has been reported at varying rates in the epidemiologic studies. Similarly, reported incidence has a high rate of variability. Nocturia causes were associated with nocturnal polyuria, bladder storage issues, metabolic syndrome, abnormal bowel habits, obesity, Parkinson's disease, global polyuria, insomnia, sleep disturbances, heart failure, anxiety, and depression. Although age was commented on in many articles, it was never the primary examined variable.
SUMMARY
There is a lack of standardization in definition and classification of the causes of nocturia. Confounding variables included a lack of use of a standard definition of nocturia, identifying nocturia at its true onset, and a fundamental underutilization of frequency volume charts to identify patients with nocturia. The confounding variables make it difficult to compare studies. Thus, the strength of conclusion on cause will be better defined when standards are set controlling definition, identification, and diagnosis.
Topics: Age Factors; Aging; Humans; Nocturia
PubMed: 24809414
DOI: 10.1097/MOU.0000000000000061 -
Urology Oct 2014
Topics: Humans; Male; Natriuretic Peptide, Brain; Nocturia; Polyuria; Sleep Apnea, Obstructive; Vasopressins
PubMed: 25096336
DOI: 10.1016/j.urology.2014.02.075 -
BMJ Case Reports Jul 2014A 13-year-old boy presented with fever, skeletal pain, polydipsia, polyuria and multiple osteolytic lesions in pelvic bones and upper femur. There was no organomegaly or...
A 13-year-old boy presented with fever, skeletal pain, polydipsia, polyuria and multiple osteolytic lesions in pelvic bones and upper femur. There was no organomegaly or lymphadenopathy. His serum calcium levels were raised. Peripheral blood film examination was normal. Bone marrow showed presence of blast cells. Flowcytometry indicated B-acute lymphoblastic leukaemia (B-ALL). Hypercalcaemia and osteolytic lesions are rare presentations of B-ALL. This should be kept as a differential if a child presents with unexplained skeletal pain with lytic lesions.
Topics: Adolescent; Bone Marrow; Bone Marrow Examination; Bone and Bones; Humans; Hypercalcemia; Male; Musculoskeletal Pain; Osteolysis; Polydipsia; Polyuria; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Radiography
PubMed: 25006054
DOI: 10.1136/bcr-2014-204050 -
Current Opinion in Nephrology and... Sep 2017Antenatal Bartter syndrome (aBS) is a heterogenous disease resulting from defective ion transport in the thick ascending limb of the loop of Henle. Novel insights into... (Review)
Review
PURPOSE OF REVIEW
Antenatal Bartter syndrome (aBS) is a heterogenous disease resulting from defective ion transport in the thick ascending limb of the loop of Henle. Novel insights into the pathophysiology, as well as the recent identification of a novel genetic cause of aBS, merit an update on this topic.
RECENT FINDINGS
In aBS, severe salt losing is further aggravated by defective salt sensing in the macula densa, where a reduced tubular salt concentration is perceived and glomerular filtration is increased instead of decreased. As patients with aBS come of age, there is an increased incidence of proteinuria and impaired renal function.Moreover, we recently reported a new form of aBS. Indeed, we described a series of nine families in whom pregnancies with male fetuses where complicated by acute polyhydramnios, preterm delivery and with severe but transient polyuria. We identified mutations in melanoma-associated antigen D2 in all study participants and showed, in vivo and in vitro, reduced expression of the furosemide and thiazide sensitive transporters sodium-potassium-2-chloride cotransporter and sodium chloride cotransporter, respectively.
SUMMARY
Genetic studies revealed the complexity of ion transport in the thick ascending limb of the loop of Henle and will help to clarify the pathophysiology, which is essential to design new therapies.
Topics: Adaptor Proteins, Signal Transducing; Antigens, Neoplasm; Bartter Syndrome; Female; Fetal Diseases; Humans; Male; Mutation; Polyhydramnios; Polyuria; Pregnancy; Premature Birth; Renal Reabsorption; Sodium Chloride; Sodium Chloride Symporters; Sodium-Potassium-Chloride Symporters
PubMed: 28598867
DOI: 10.1097/MNH.0000000000000346 -
Urology Nov 2019Nocturnal polyuria (NP), the most common etiology of nocturia, can be caused by various medical conditions, including cardiovascular disease, obstructive sleep apnea,... (Review)
Review
Nocturnal polyuria (NP), the most common etiology of nocturia, can be caused by various medical conditions, including cardiovascular disease, obstructive sleep apnea, renal tubular dysfunction, as well as medications (eg, diuretics) and/or behavioral patterns. NP in the absence of underlying medical conditions has been described as NP syndrome and is thought be the result of impaired circadian release of endogenous arginine vasopressin. Desmopressin, a synthetic arginine vasopressin analog, has been shown to be an effective replacement therapy in adults with nocturia due to NP. Further studies on the subset of patients with NP syndrome are warranted to maximize benefit from antidiuretic treatment. In addition, a connection between the pathophysiological mechanisms underlying NP and essential hypertension has been suggested, and hypertension has been shown to be a significant risk factor for nocturia, while an association between NP and brain natriuretic peptide levels has also been reported in patients with nocturia. Hypertension is now viewed as a disorder of blood vessels and treatment is directed at the vasculature rather than the blood pressure, with the latter currently serving as a biomarker for arterial injury. Nocturia is thought to be associated with the beginning of this cardiovascular continuum as studies have reported a link between coronary heart disease and nocturia. Therefore, there is an increasing need to elucidate the complex mechanisms implicated in the association between nocturia and hypertension to promote the development of more individualized therapies for the treatment of nocturia.
Topics: Forecasting; Humans; Hypertension; Natriuretic Peptide, Brain; Nocturia; Polyuria; Prevalence; Vascular Diseases; Vascular Stiffness
PubMed: 31233816
DOI: 10.1016/j.urology.2019.06.014 -
European Urology Focus May 2020We review the role of the heart, kidneys, and bladder in the pathophysiology of nocturia and nocturnal polyuria. Lower urinary tract symptoms such as nocturia have often... (Review)
Review
We review the role of the heart, kidneys, and bladder in the pathophysiology of nocturia and nocturnal polyuria. Lower urinary tract symptoms such as nocturia have often been associated with lower urinary tract dysfunction. It is known that the bladder contributes to nocturia in the case of low functional capacity, urgency, and detrusor overactivity. Heart diseases, especially arterial hypertension and congestive heart failure, are closely related to nocturnal polyuria. The main mechanisms include renal hyperfiltration and elevated atrial natriuretic peptide. A number of drugs frequently used in cardiovascular disorders are implicated in nocturia; diuretics, calcium channel blockers, and β-blockers induce nocturnal polyuria and thus nocturia, whereas alpha-blockers improve nocturia. Among the different forms of hypertension, nondipping arterial hypertension has been associated with a higher risk of nocturnal polyuria. Besides the role of the kidneys in nocturia linked to arterial hypertension, chronic kidney disease is an independent predictor of nocturia through an osmotic diuresis mechanism. Some evidence suggests a close relationship between the heart (nondipping arterial hypertension), kidneys (chronic kidney disease), and nocturia/nocturnal polyuria. These complex interactions between the heart, kidneys, and bladder warrant a multidisciplinary approach in patients with nocturia. PATIENT SUMMARY: We review the different mechanisms that lead to nocturia and nocturnal polyuria. The complex interactions between the heart, the kidneys, and the bladder warrant a multidisciplinary approach in patients with nocturia. Careful investigation of the cause of nocturia can improve its management.
Topics: Heart; Heart Diseases; Humans; Kidney; Kidney Diseases; Nocturia; Urinary Bladder; Urinary Bladder Diseases
PubMed: 31395515
DOI: 10.1016/j.euf.2019.07.007 -
Frontiers in Endocrinology 2022Central diabetes insipidus (CDI) is a rare endocrine disease deriving from an insufficient production or secretion of anti-diuretic hormone. Recently, CDI has been... (Review)
Review
Central diabetes insipidus (CDI) is a rare endocrine disease deriving from an insufficient production or secretion of anti-diuretic hormone. Recently, CDI has been reported as a rare side effect triggered by immune checkpoint inhibitors (ICI) in cancer patients. Despite its current rarity, CDI triggered by ICI is expected to affect an increasing number of patients because of the expanding use of these effective drugs in a growing number of solid and hematologic malignancies. An appropriate assessment of the severity of adverse events induced by anticancer agents is crucial in their management, including dosing adjustment and temporary withdrawal or discontinuation treatment. However, assessment of the severity of CDI induced by ICI may be challenging, as its main signs and symptoms (polyuria, dehydration, weight loss, and hypernatremia) can be incompletely graded. Indeed, the current grading system of toxicity induced by anticancer treatments does not include polyuria. Additionally, dehydration in patients affected by diabetes insipidus, including ICI-induced CDI, is different in certain aspects from that due to other conditions seen in cancer patients, such as vomiting and diarrhea. This prompted us to reflect on the need to grade polyuria, and how to grade it, and to consider a specific grading system for dehydration associated with CDI induced by ICI. Here we propose a new grading system for polyuria and dehydration, as critical symptoms of the CDI syndrome occurring in patients on ICI treatment, to obtain better management of both the adverse event and the triggering drugs.
Topics: Dehydration; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Humans; Immune Checkpoint Inhibitors; Neoplasms; Polyuria
PubMed: 35388297
DOI: 10.3389/fendo.2022.840971 -
International Urology and Nephrology Oct 2020A recent update in International Continence Society (ICS) terminology now recognizes nocturnal polyuria (NP) and diurnal polyuria (DP) as related subcategories of...
PURPOSE
A recent update in International Continence Society (ICS) terminology now recognizes nocturnal polyuria (NP) and diurnal polyuria (DP) as related subcategories of "Polyuria (global symptom)". This study determines the real-world clinical overlap between NP, DP, and 24-h polyuria (24hP) among men with nocturia.
METHODS
Analysis of frequency-volume charts from men ≥ 18 years with ≥ 1 nocturnal void(s). Three separate analyses were performed using different rate criteria for NP, DP, and 24hP: (1) urine production > 90 mL/h (extrapolated from a proposed definition for NP); (2) > 125 mL/h (extrapolated from a proposed definition for 24hP [3000 mL/24 h]); and (3) > 1.67 mL/kg/h (extrapolated from the current ICS definition for 24hP [> 40 mL/kg/24 h]). Subjects were categorized as having one of five mathematically permissible phenotypic combinations: (1) isolated NP, (2) isolated DP, (3) NP + 24hP, (4) DP + 24hP, and (5) NP + DP + 24hP.
RESULTS
167, 95, and 61 patients were included at criteria 1, 2, and 3, respectively, with 56%, 43%, and 30% of patients demonstrating overlapping phenotypes (i.e., phenotypic combinations 3-5) at cut-offs 1-3, respectively. The prevalence of NP was similar across cut-offs (81-87%), but the prevalence of NP without 24hP was highly threshold-dependent (43-73%).
CONCLUSION
Consistent with current ICS terminology, there exists a substantial overlap between NP, DP, and 24hP. As demonstrated in the current study, absolute volume-based criteria for NP/DP/24hP are indeed conducive to the diagnosis of concurrent NP + 24hP, and may be preferred over proportion-based NP criteria when both NP + 24hP are suspected.
Topics: Aged; Humans; Male; Middle Aged; Nocturia; Polyuria; Retrospective Studies; Terminology as Topic; Time Factors
PubMed: 32435976
DOI: 10.1007/s11255-020-02502-1