7/17/2023 0 Comments Nocturnal polyuria in young adults![]() ![]() Lower urinary tract pathology may present with frequent small volume voids often in association with other lower urinary tract symptoms (LUTS). Obstructive sleep apnoea (OSA) causes NP due to increased secretion of atrial natriuretic peptide, which induces a natriuresis. This excess fluid is then excreted by the kidneys. Peripheral oedema can result in NP as the accumulated fluid is redistributed to the intravascular compartment once recumbent in bed. This can occur from central nervous system lesions that affect the hypothalamicpituitary axis, but it can also occur in elderly patients without specific central nervous system pathology. Nocturnal polyuria can be caused by low nocturnal ADH levels. 13 Nocturnal polyuria is present in up to 80% of patients with nocturia and can be easily overlooked if a FVC is not completed. Nocturnal polyuria exists when the nocturnal urine volume represents >20% of the 24 hour voided volume in younger adults and >33% in patients aged 65 years and over. Nocturnal polyuria (NP) is increased urine production at night. Global polyuria can also result from diabetes insipidus. Polydipsia can also be a compensatory mechanism for fluid loss, such as the osmotic diuresis of uncontrolled diabetes mellitus. 1 The most common cause is primary polydipsia. Global polyuria is continuously raised urine output defined as >40 mL/kg/24 hours. Largest single volume voided (usually between 300–600 mL) Total volume urine passed during the night: The first void after waking with the intention of rising Total volume of urine voided in a 24 hour period Number of voids recorded during a night's sleep, each void is preceded and followed by sleep Definitions of terms derived from the frequency-volume chart Term Once the diary has been completed by the patient, important values can be calculated (Table 1). The period recorded needs to be representative of the patient's typical symptoms. It is usally more convenient for patients to choose a time when they are mostly at home to complete their voiding diary. Giving clear instructions before patients complete the chart improves compliance and eliminates the need for multiple diaries. time, type and volume of fluids ingested.volumes and times of urination for a 24–72 hour period 1.Classification of nocturia The frequency-volume chartĪ frequency-volume chart (FVC) – or 'voiding diary' – distinguishes between the three categories of nocturia. Nocturia can be categorised into three clinical entities based on the pattern of 24 hour urine (Figure 1):įigure 1. This may be partly responsible for the increased prevalence that occurs with advancing age. 10 In elderly patients with nocturia this rhythm is often blunted with reduced nocturnal levels of ADH. Normally, ADH increases during sleep resulting in smaller volumes of concentrated urine. 8,9 Circadian control of urine productionĪntidiuretic hormone (ADH) is released by the posterior pituitary and increases water reabsorption at the renal collecting tubule. ![]() 6 Younger sufferers are more likely to be female, however, prevalence is similar in both genders in older patients. 8 A substantial proportion of younger adults are affected with up to 30% of those aged 20–40 years voiding at least once per night. More than 70% of people aged 70 years and over are affected. The prevalence of nocturia increases with age. Nocturia affects bed partners and carers and can cause relationship disturbances.Nocturia is a predictor of mortality, with higher mortality risk with increased number of nightly voids 6.Fall and hip fracture risk is increased in elderly patients with nocturia 5.Decreased sleep can cause daytime fatigue, poor concentration, memory impairment, mood alterations and affects work performance 4.The severity of sleep impairment increases with the number of nocturnal voids 3.Nocturia typically becomes bothersome to patients when it occurs more than two times per night 3.Nocturia has a profound impact on quality of life, being comparable to gout, hypertension, diabetes and angina in terms of disease burden 2.The impact of nocturia on quality of life ![]()
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