-
Minerva Urology and Nephrology Feb 2022
Topics: COVID-19; Humans; Polyuria; SARS-CoV-2
PubMed: 33887897
DOI: 10.23736/S2724-6051.21.04396-2 -
Journal of Clinical Neuroscience :... May 2023Primary suprasellar germinoma (PSG) is a rare malignant tumor of the central nervous system. This study aimed to explore the clinical characteristics, treatment...
Primary suprasellar germinoma (PSG) is a rare malignant tumor of the central nervous system. This study aimed to explore the clinical characteristics, treatment protocol, and prognosis of patients with PSG. This case series retrospectively analyzed the clinical data of patients with PSG in Tianjin Huanhu Hospital diagnosed between January 2016 and December 2021. Fifteen patients with an average age of 19.6 years were included, in which nine of them were males. The mean duration between initial symptoms and admission was 17.0 months. The mean follow-up was 40.8 months. Ten patients had polydipsia and polyuria, visual impairments were observed in 8 patients, and 2 cases (13.3%) had symptoms both from suprasellar and pineal regions. All 15 cases were histopathologically confirmed as germinoma through craniotomy or biopsy. Most patients (80%) underwent radiotherapy combined with chemotherapy. During follow-up, all the patients showed a reduction in tumor size, especially in the bifocal cases. Symptoms of polydipsia, polyuria, and visual impairment were markedly relieved to different degrees. All patients had recovered well at discharge. Patients with polydipsia and polyuria took desmopressin daily. A histological confirmation by open biopsy through craniotomy or endoscopic biopsy might be recommended for PSG to start the appropriate treatments. Patients with PSG will usually have a good prognosis, but attention should be paid to the treatment of endocrine deficiencies.
Topics: Male; Humans; Young Adult; Adult; Female; Brain Neoplasms; Retrospective Studies; Polyuria; Germinoma; Central Nervous System Neoplasms; Head and Neck Neoplasms
PubMed: 36963125
DOI: 10.1016/j.jocn.2023.03.007 -
International Journal of Urology :... Sep 2021To evaluate whether the efficacy of desmopressin differs between patients with and without nocturnal polyuria.
OBJECTIVES
To evaluate whether the efficacy of desmopressin differs between patients with and without nocturnal polyuria.
METHODS
A total of 65 treatment-naïve children with monosymptomatic nocturnal enuresis were enrolled (45 boys; median age 8.9 years). Patients received desmopressin as their first-line treatment. Four different standards were used (Akashi and Hoashi >0.9 mL/kg/sleeping hour; Hamano >[age + 2] × 25 × 130% mL; the International Children's Continence Society >[age + 1] × 30 × 130% mL; and Rittig >[age + 9] × 20 mL) to assess nocturnal polyuria. The effectiveness of desmopressin was compared between patients with and without nocturnal polyuria according to each standard. A response was defined as a reduction in wet nights of >50%.
RESULTS
The desmopressin treatment efficacy rate was 54% for polyuria and 67% for non-polyuria patients (P = 0.20), 45% for polyuria and 68% for non-polyuria patients (P = 0.08), 54% for polyuria and 59% for non-polyuria patients (P = 0.80), and 52% for polyuria and 61% for non-polyuria patients (P = 0.61), for the Akashi and Hoashi's, Hamano's, International Children's Continence Society and Rittig's standards, respectively.
CONCLUSIONS
No difference was observed in the short-term clinical efficacy of desmopressin regardless of the presence of nocturnal polyuria. Thus, this might be a feasible treatment option for patients with nocturnal enuresis without nocturnal polyuria.
Topics: Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Infant; Japan; Male; Nocturnal Enuresis; Polyuria
PubMed: 34169597
DOI: 10.1111/iju.14615 -
JAMA Network Open Dec 2022Despite access to routine laboratory evaluation, primary hyperparathyroidism (PHP) remains underdiagnosed and undertreated.
IMPORTANCE
Despite access to routine laboratory evaluation, primary hyperparathyroidism (PHP) remains underdiagnosed and undertreated.
OBJECTIVE
To determine the consequences associated with missed diagnoses and prolonged time to diagnosis and treatment of PHP.
DESIGN, SETTING, AND PARTICIPANTS
This is a retrospective cohort study of patients older than 40 years with 2 instances of hypercalcemia during 2010 to 2020 and 3 years of follow-up. Patients were recruited from 63 health care organizations in the TriNetX Research Network. Data analysis was performed from January 2010 to September 2020.
EXPOSURES
Elevated serum calcium.
MAIN OUTCOMES AND MEASURES
Existing symptoms and diagnoses associated with PHP (osteoporosis, fractures, urolithiasis, major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, constipation, insomnia, polyuria, weakness, abdominal pain, headache, nausea, amnesia, and gallstones) compared in patients deemed high-risk and without a diagnosis and matched controls, and those who experienced times from documented hypercalcemia to diagnosis and diagnosis to treatment within or beyond 1 year.
RESULTS
There were 135 034 patients analyzed (96 554 women [72%]; 28 892 Black patients [21%] and 88 010 White patients [65%]; 3608 Hispanic patients [3%] and 98 279 non-Hispanic patients [73%]; mean [SD] age, 63 [10] years). Two groups without a documented diagnosis of PHP were identified as high risk: 20 176 patients (14.9%) with parathyroid hormone greater than or equal to 50 pg/mL and 24 905 patients (18.4%) with no parathyroid hormone level obtained or recorded explanation for hypercalcemia. High-risk patients experienced significantly increased rates of all associated symptoms and diagnoses compared with matched controls. Just 9.7% of those with hypercalcemia (13 136 patients) had a diagnosis of PHP. Compared with individuals who received a diagnosis within 1 year of hypercalcemia, those whose workup exceeded 1 year had significantly increased rates of major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, polyuria, weakness, abdominal pain, and headache at 3 years. The rate of osteoporosis increased from 17.1% (628 patients) to 25.4% (935 patients) over the study period in the group with delayed diagnosis. Among those with a diagnosis, 5280 patients (40.2%) underwent parathyroidectomy. Surgery beyond 1 year of diagnosis was associated with significantly increased rates of osteoporosis and hypertension at 3 years after diagnosis compared with those treated within 1 year.
CONCLUSIONS AND RELEVANCE
Many patients were at high risk for PHP without a documented diagnosis. Complications in these patients, as well as those who received a diagnosis after prolonged workup or time to treatment, resulted in patient harm. System-level interventions are necessary to ensure proper diagnosis and prompt treatment of PHP.
Topics: Adult; Female; Humans; Middle Aged; Calcium; Depressive Disorder, Major; Hypercalcemia; Hyperparathyroidism, Primary; Osteoporosis; Parathyroid Hormone; Polyuria; Retrospective Studies; Aged; Male
PubMed: 36574247
DOI: 10.1001/jamanetworkopen.2022.48332 -
Endocrine Reviews Sep 2021Diabetes has been known since antiquity. We present here a historical perspective on the concepts and ideas regarding the physiopathology of the disease, on the...
Diabetes has been known since antiquity. We present here a historical perspective on the concepts and ideas regarding the physiopathology of the disease, on the progressive focus on the pancreas, in particular on the islets discovered by Langerhans in 1869, leading to the iconic experiment of Minkowski and von Mering in 1889 showing that pancreatectomy in a dog induced polyuria and diabetes mellitus. Subsequently, multiple investigators searched for the active substance of the pancreas and some managed to produce extracts that lowered blood glucose and decreased polyuria in pancreatectomized dogs but were too toxic to be administered to patients. The breakthrough came 100 years ago, when the team of Frederick Banting, Charles Best, and James Collip working in the Department of Physiology headed by John Macleod at the University of Toronto managed to obtain pancreatic extracts that could be used to treat patients and rescue them from the edge of death by starvation, the only treatment then available. This achievement was quickly recognized by the Nobel Prize in Physiology or Medicine to Banting and Macleod in 1923. At 32, Banting remains the youngest awardee of this prize. Here we discuss the work that led to the discovery and its main breakthroughs, the human characters involved in an increasingly dysfunctional relationship, the controversies that followed the Nobel Prize, and the debate as to who actually "discovered" insulin. We also discuss the early commercial development and progress in insulin crystallization in the decade or so following the Nobel Prize.
Topics: Animals; Blood Glucose; Diabetes Mellitus; Dogs; Female; History, 20th Century; Humans; Insulin; Male; Nobel Prize; Polyuria
PubMed: 34273145
DOI: 10.1210/endrev/bnab020 -
Aktuelle Urologie Sep 2017
Review
Topics: Deamino Arginine Vasopressin; Double-Blind Method; Humans; Male; Nocturia; Polyuria; Urinary Bladder
PubMed: 28854455
DOI: 10.1055/s-0043-110111 -
The Turkish Journal of Pediatrics 2022Monosymptomatic nocturnal enuresis (MNE) is defined as involuntary nighttime urination of children over five years of age without any congenital or acquired defect in...
BACKGROUND
Monosymptomatic nocturnal enuresis (MNE) is defined as involuntary nighttime urination of children over five years of age without any congenital or acquired defect in the central nervous system. Many factors, mainly nocturnal polyuria, sleep disorders, decreased bladder capacity, and bladder dysfunctions play a role in the etiology of MNE.
METHODS
Eighty-three children diagnosed with MNE were included in the study. Complete blood cell count, blood biochemistry, renin, and aldosterone levels of all children were obtained. Twenty-four-hour urine samples were collected separately daytime and nighttime and urinary electrolytes were evaluated. Also, 24-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. The results were evaluated by comparing both enuretic children vs. control group and enuretic children with polyuria vs. without polyuria.
RESULTS
When we compared the enuretic children and the control group in terms of urinary electrolytes, the fractional excretion of sodium (FENa) and fractional excretion of potassium (FEK) values of the enuretic group were higher than the control. The evaluation of the 24-hour ABPM findings revealed no significant difference in terms of the mean arterial pressure (MAP) and diastolic blood pressure (DBP) during the daytime and nighttime measurements. The daytime systolic blood pressure (SBP), however, was significantly lower in the enuretic group. When enuretic children with and without polyuria and the control group were compared, the nighttime, FENa, FEK, as well as nighttime urinary excretion of calcium and protein were significantly higher in enuretic children with polyuria. No difference was detected on the MAP, SBP, or DBP values.
CONCLUSIONS
In conclusion, the nighttime urinary solute excretion of enuretic children was found to be higher and this condition may especially be associated with pathogenesis of nighttime polyuria. In enuretic children, nighttime blood pressure changes were not influential in the etiopathogenesis in all patient groups and multiple mechanisms may play a role in the pathogenesis of enuresis.
Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Child; Electrolytes; Humans; Nocturnal Enuresis; Polyuria
PubMed: 35611421
DOI: 10.24953/turkjped.2020.3343 -
European Urology Focus Jan 2022Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-h polyuria. Nocturia can arise early in chronic kidney disease (CKD).... (Review)
Review
CONTEXT
Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-h polyuria. Nocturia can arise early in chronic kidney disease (CKD). Evidence-based recommendations can facilitate management outside nephrology clinics.
OBJECTIVE
To conduct a systematic review (SR) of nocturia in CKD and achieve expert consensus for management in primary care and in specialist clinics outside nephrology.
EVIDENCE ACQUISITION
Four databases were searched from January 2000 to April 2020. A total of 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. Seven studies met the inclusion criteria and two were identified through other sources. Consensus was achieved among an expert panel with public involvement using the nominal group technique (NGT).
EVIDENCE SYNTHESIS
Several plausible mechanisms contribute to nocturnal or 24-h polyuria in CKD, but there is little evidence on interventions to improve nocturia. NGT assessment recommendations for nocturia (at least two voids per night) in patients with CKD or at risk of CKD being assessed in a non-nephrology setting are: history (thirst, fluid intake), medication review (diuretics, lithium, calcium channel antagonists, nonsteroidal anti-inflammatory medications), examination (oedematous state, blood pressure), urinalysis (haematuria and albumin/creatinine ratio), blood tests (blood urea, serum creatinine and electrolytes, estimated glomerular filtration rate), and a bladder diary. Renal ultrasound should follow local CKD guidelines. Treatment options include optimising blood pressure control, dietary adjustment to reduce salt intake, fluid advice, and a medication review. Referral to specialist nephrology services should follow local guidelines.
CONCLUSIONS
CKD should be considered when evaluating patients with nocturia. The aim of assessment is to identify mechanisms and instigate therapy, but the latter may be more applicable to reducing wider morbidity associated with CKD than nocturia itself.
PATIENT SUMMARY
People with kidney disease can suffer severe sleep disturbance because of a need to pass urine overnight. We looked at published research and found some useful information about the underlying mechanisms. A group of experts was able to develop practical approaches for assessing and treating this condition.
Topics: Consensus; Humans; Nocturia; Polyuria; Primary Health Care; Renal Insufficiency, Chronic
PubMed: 35031353
DOI: 10.1016/j.euf.2021.12.010 -
The New England Journal of Medicine Aug 2018
Topics: Diabetes Insipidus; Diagnostic Tests, Routine; Humans; Polyuria
PubMed: 30067935
DOI: 10.1056/NEJMe1808195 -
European Urology Focus Jan 2022Although nocturia, affecting mainly the elderly population, is a urinary tract symptom, it may also be a part of conditions not related to the urinary tract. In this...
BACKGROUND
Although nocturia, affecting mainly the elderly population, is a urinary tract symptom, it may also be a part of conditions not related to the urinary tract. In this scenario, nocturia terminology is crucial to avoid confusion and misunderstanding across different specialities. The International Continence Society (ICS) provides the updated nocturia terminology.
OBJECTIVE
To review, describe, and explain the applicability of nocturia terminology based on the ICS standardisation documents.
DESIGN, SETTING, AND PARTICIPANTS
The ICS report provides definitions on the terminology for nocturia and nocturnal lower urinary tract function, which were identified and summarised.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Terminology was classified as symptoms and signs, and an explanation of how terms are applied in a bladder diary for use in clinical practice was given.
RESULTS AND LIMITATIONS
Terminology was classified into symptoms and signs. Nocturia is a symptom where the patient reports waking up to pass urine during their main sleep period, and every episode is followed by sleep or the intention to sleep. Nocturnal polyuria is a symptom when the patient perceives that they have passed large volumes of urine during the main sleep period. Enuresis is the complaint of incontinence that occurs while a patient is asleep and is usually unaware of it. All these terms can be a sign when quantified on the bladder diary. The remaining terminology is identified and quantified on the 3-d bladder diary (24-h voided volume, 24-h polyuria, nocturnal urine volume, night-time frequency, first morning void, night-time main sleep period).
CONCLUSIONS
The health care provider must understand the critical differences between the different terms. It will facilitate communication among all the professionals involved in the care of these patients. A 3-d bladder diary is a fundamental tool for assessing nocturia.
PATIENT SUMMARY
This paper has the objective of defining and explaining all the terms currently used for nocturia. For this purpose, we utilised the published standard terminology and summarised it with examples for better understanding and applicability.
Topics: Aged; Humans; Nocturia; Polyuria; Urinary Bladder; Urinary Incontinence; Urination
PubMed: 35094963
DOI: 10.1016/j.euf.2022.01.008