Urinary Frequency and Polyuria



Urinary Frequency and Polyuria


Matthew Sampson



INTRODUCTION

A perceived increase in urination is a common concern that a pediatrician may be asked to evaluate. A key task is to differentiate true polyuria from urinary frequency. Polyuria, defined formally as urine output 2,000 mL/1.73 m2 over 24 hours, is usually caused by excessive fluid intake, a lack of release of antidiuretic hormone (ADH), tubular insensitivity to ADH, or an osmotic diuresis. In rare cases, it results from relief of urinary obstruction (“postobstructive dieresis”) or is the polyuric phase of recovery from acute tubular necrosis. Urinary frequency not associated with polyuria is a common finding in children most typically caused by urinary tract infection (UTI), pollakiuria (frequent daytime urination), or chemical irritation.


DIFFERENTIAL DIAGNOSIS LIST


Infectious Causes



  • Pyelonephritis


  • Meningoencephalitis


  • Congenital cytomegalovirus and toxoplasmosis


Toxic Causes



  • Recovery phase of acute tubular necrosis (typically caused by medications/toxins or hypoperfusion)


  • Furosemide


  • Aminoglycosides


  • Phenytoin


  • Demeclocycline


  • Amphotericin B


  • Vinblastine


  • Cisplatin


  • Lithium


Metabolic or Genetic Causes



  • Inherited nephrogenic diabetes insipidus (NDI)


  • Sickle cell disease


  • Fanconi syndrome (e.g., cystinosis)


  • Polycystic kidney disease


  • Familial juvenile nephronophthisis


  • Bartter syndrome


  • Diabetes insipidus, diabetes mellitus, optic atrophy, and deafness syndrome


  • Laurence-Moon-Biedl syndrome


Psychosocial Causes



  • Primary polydipsia


Miscellaneous Causes



  • Postobstructive diuresis


  • Diabetes mellitus


  • Idiopathic central diabetes insipidus


  • Hand-Schüller-Christian disease


  • Sarcoidosis


  • Sjögren syndrome



Neoplastic Causes



  • Craniopharyngioma


  • Meningioma


  • Glioma


  • Metastasis—lymphoma, leukemia


Traumatic Causes



  • Severe head trauma


  • Hypophysectomy


Congenital or Vascular Causes



  • Obstructive uropathy


  • Cerebral hemorrhage


Urinary Frequency



  • Cystitis


  • Urethritis


  • Constipation


  • Pollakiuria


  • Hypercalciuria


  • Neuropathic bladder


DIFFERENTIAL DIAGNOSIS DISCUSSION


Central Diabetes Insipidus


Etiology

Central diabetes insipidus is urinary loss of water caused by impairment of vasopressin (ADH) production in the central nervous system (CNS) and may be idiopathic, acquired, or inherited. Approximately one-third of affected infants and children have the idiopathic (primary) form. Secondary causes include trauma, tumors (especially craniopharyngioma), hemorrhage, CNS infection, hypoxia, and Langerhans cell histiocytosis. The autosomal dominant form of central diabetes insipidus is rare.


Clinical Features

Children present with a sudden onset of polyuria, nocturia, and polydipsia with a predilection for cold water. Hypernatremia and dehydration do not occur if the thirst mechanism is intact and there is ample access to water. There are no specific abnormal physical findings in primary central diabetes insipidus.


Evaluation

Laboratory studies reveal a consistently low urine osmolality, but in the absence of dehydration, it is difficult to distinguish central diabetes insipidus from NDI and psychogenic polydipsia. A water-deprivation study is diagnostic for central diabetes insipidus when the serum osmolality is increased and the urine osmolality and the plasma vasopressin concentration remain decreased in the face of strict withholding of water. A brisk response, as measured by an increase in urine osmolality, to the administration of exogenous ADH is expected.

Radiographic imaging of the head is necessary to exclude secondary causes.


Sep 14, 2016 | Posted by in PEDIATRICS | Comments Off on Urinary Frequency and Polyuria

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