TABLE 96 Frequency Nocturia and Polyuria

Problem

Mechanisms

Selected Causes

Associated Symptoms

Frequency

Nocturia

With High Volumes

With Low Volumes

Polyuria

Decreased capacity of the bladder

■ Increased bladder sensitivity to stretch because of inflammation

■ Decreased elasticity of the bladder wall

■ Decreased cortical inhibition of bladder contractions

Impaired emptying of the bladder, with residual urine in the bladder

■ Partial mechanical obstruction of the bladder neck or proximal urethra

Loss of peripheral nerve supply to the bladder

Most types of polyuria (see pp. 327-328)

Decreased concentrating ability of the kidney with loss of the normal decrease in nocturnal urinary output

Excessive fluid intake before bedtime

Fluid-retaining, edematous states. Dependent edema accumulates during the day and is excreted when the patient lies down at night.

Frequency

Voiding while up at night without a real urge, a "pseudo-frequency"

Deficiency of antidiuretic hormone (diabetes insipidus)

Renal unresponsiveness to antidiuretic hormone (nephrogenic diabetes insipidus)

Solute diuresis

■ Electrolytes, such as sodium salts

■ Nonelectrolytes, such as glucose Excessive water intake

Infection, stones, tumor, or foreign body in the bladder

Infiltration by scar tissue or tumor

Motor disorders of the central nervous system, such as a stroke

Most commonly, benign prostatic hyperplasia; also urethral stricture and other obstructive lesions of the bladder or prostate

Neurologic disease affecting the sacral nerves or nerve roots, e.g., diabetic neuropathy

Chronic renal insufficiency due to a number of diseases

Habit, especially involving alcohol and coffee

Congestive heart failure, nephrotic syndrome, hepatic cirrhosis with ascites, chronic venous insufficiency

Insomnia

A disorder of the posterior pituitary and hypothalamus

A number of kidney diseases, including hypercalcemic and hypokalemic nephropathy; drug toxicity, e.g., from lithium

Large saline infusions, potent diuretics, certain kidney diseases Uncontrolled diabetes mellitus

Primary polydipsia

Burning on urination, urinary urgency, sometimes gross hematuria

Symptoms of associated inflammation (see above) are common.

Urinary urgency; neurologic symptoms such as weakness and paralysis

Prior obstructive symptoms: hesitancy in starting the urinary stream, straining to void, reduced size and force of the stream, and dribbling during or at the end of urination Weakness or sensory defects

Possibly other symptoms of renal insufficiency

Edema and other symptoms of the underlying disorder. Urinary output during the day may be reduced as fluid reaccumulates in the body. See Table 14-4, Some Peripheral Causes of Edema.

Variable

Thirst and polydipsia, often severe and persistent; nocturia

Thirst and polydipsia, often severe and persistent; nocturia

Variable

Thirst, polydipsia, and nocturia

Polydipsia tends to be episodic. Thirst may not be present. Nocturia is usually absent.

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