Polyuria Treatment in Delhi, India

Polyuria is a condition that is characterized by the production of excess amounts of urine per day. On a daily basis, our body makes about 1.5 to 2 litres of urine, whereas, in this condition, the body has a tendency to make about 4-5 litres of urine. It is a classic sign of diabetes. As a result of this, there is an urge to urinate several times both during the day and night.

Symptoms of Polyuria

Frequent urination is the most common symptom noticed during this condition. It is accompanied by polydipsia, which refers to an increase in the amount of thirst and night-time frequency of urination. Apart from these, various other symptoms are as follows:

• Weight loss: Prompt weight loss is indicative of Type I diabetes. It is also a feature of chronic kidney disease and may occur due to dehydration.
• Malaise: Polyuria can result in severe dehydration, leading to malaise and fatigue.
• Headache: This condition can give rise to severe headaches due to increased pressure in the brain. 
• Blood pressure fluctuations: Polyuria results in dehydration, which can lead to increased heart rate.

Causes of Polyuria

Polyuria is mainly caused due to the following factors:

• Renal
• Endocrine
• Iatrogenic
• Metabolic
• Psychological

Renal causes

• Nephrogenic Diabetes Insipidus: The role of the Anti-Diuretic Hormone (ADH) is to conserve water by decreasing urine excretion. The inability of kidneys to react to ADH results in polyuria. The inability of kidneys to respond to ADH can be hampered by various chronic disorders, namely polycystic kidney disease, sickle cell anaemia, kidney failure, partial ureter blockage, and inherited genetic disorders as well.
• Fanconi's Syndrome: In this syndrome, the kidneys are unable to function optimally, as a result of which they fail to reabsorb certain biomolecules and ions, thereby resulting in polyuria. 
• Chronic Pyelonephritis: This is the inflammation of the kidneys due to bacterial infection. Persistent chronic infections give rise to scarring and altered kidney function, causing polyuria. 
• Chronic Kidney Disease (CKD): This condition leads to the gradual deterioration of kidney function resulting in nocturnal polyuria.

Endocrine causes

• Diabetes Mellitus: Diabetes mellitus, if uncontrolled, can result in polyuria due to osmotic diuresis. 
• Central Diabetes Insipidus: Diabetes insipidus exhibits excessive excretion of water in the urine. In central diabetes insipidus, polyuria occurs mainly because of trauma, injury, tumours, and brain lesions.
• Cushing's syndrome: Frequent urination is a prominent symptom of Cushing's syndrome, which can occur due to a pituitary gland tumour and ACTH-secreting tumour.

Iatrogenic causes 

• Diuretics: Polyuria can occur because of intake of diuretics in order to excrete excess water in the body, as seen in heart failure or peripheral oedema.
• Alcohol: Consumption of too much alcohol can cause polyuria.
• Lithium: A patient with a history of lithium use for treating bipolar disorder can result in polyuria.
• Tetracycline: Polyuria is a potentially adverse side-effect of antibiotics like tetracycline.

Metabolic causes 

• Hypercalcemia: An increase in the blood levels of calcium is termed hypercalcemia. This occurs as a consequence of calcium supplementation during osteoporosis, bone cancer or hyperparathyroidism. 
• Hypokalemia: In this condition, the amount of blood concentration of potassium decreases due to chronic diarrhoea, diuretic use, and primary hyperaldosteronism.

Psychological causes

• Polyuria can occur due to excessive and unnecessary drinking of water, known as psychogenic polydipsia. This occurs as a result of anxiety or any previous history of psychiatric illness.
• Polyuria can occur because of complications of psychotic illness.

Diagnosis of Polyuria

Diagnosis is divided into the following stages:

• Medical History
• Physical Examination
• Laboratory Investigations

Medical History

The doctor goes through a detailed medical history of the patient. Facts regarding the consumption of fluid volume and voided urine help distinguishing between polyuria and urinary frequency. Certain queries like age of onset, rate of onset (abrupt vs gradual), and presence of any clinical factors which may precipitate polyuria will be asked by the doctor.

Physical Examination

A brief physical examination of the patient will be carried out to eliminate other likely causes for the symptoms being presented by the patient, hence confining the differential diagnosis and making the diagnosis easier for the Polyuria doctor.

Laboratory Investigations

Urine Test: Urinalysis is carried out to identify the presence of any abnormal substances. The most common examples are glycosuria and ketonuria in urine, which suggest diabetes mellitus, whereas proteinuria indicates kidney disease.

Blood Test:

• Fasting Blood Glucose: This is measured to see if diabetes mellitus is present as uncontrolled diabetes, therefore being a routine cause for polyuria.
• Measurement of Serum Electrolytes: Abnormal levels of the serum electrolytes, calcium and potassium are suggestive of chronic kidney disease. Elevation of serum sodium occurs in nephrogenic diabetes insipidus, whereas a decrease in the levels of serum sodium is indicative of polydipsia.
• Complete Blood Count: In the case of anaemia, the haemoglobin level drops considerably. The presence of anaemia in terms of polyuria might be indicative of CKD.
• Erythrocyte Sedimentation Rate: During polyuria, the ESR level is elevated in collagen vascular diseases and myeloma.

Specialized Investigations: X-ray, ultrasonography, and computed tomography (CT) scans of the abdomen may be carried out to assess the condition of the kidneys and urinary tract.

Treatment of Polyuria

Treatment varies with the type of causes involved in aggravating polyuria.

• In case of severe dehydration, hospitalization is strictly advised to correct the fluid and electrolyte imbalance.
• In the case of diabetes, changing of dosage or even medication is recommended.
• At home, reduce the intake of fluids.
• Thorough evaluation of treatment by the clinician is required in these patients.

Review

Reviewed by Dr. Vijay Kumar, Director & Unit Head ( Reconstructive & Laparoscopic Urology), Urology.