ABSTRACT
OBJECTIVE: Postmenopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. DESIGN, SETTING, POPULATION AND METHODS: Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. A total of 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. RESULTS: Overall, 91.5% reported nocturia, 55% ≥2 /night. There was a difference of 167.5 ml (P < 0.001) in nocturnal urine volume between women with nocturia ≥2 (median 736 ml) versus less often (517 ml). Significant predictors of self-reported disruptive nocturia were age (odds ratio [OR] 1.04, 95% CI 1.002-1.073) and vitamin D supplementation (OR 2.33, 95% CI 1.11-4.91). Nocturnal polyuria was significantly more common with nocturia ≥2 compared with less frequent nocturia (P < 0.002). Exercise for 150 minutes a week was protective for nocturnal polyuria (OR 0.22, P = 0.001). Nocturia index >1.3 was significantly predicted by age (OR 1.07, P < 0.001), regular exercise (OR 0.41, P = 0.036), day flushes (OR 4.00, P = 0.013) and use of vitamin D (OR 2.34, P = 0.043). Maximum voided volumes were significantly lower with nocturia ≥2 versus less often (night: 268 ml versus 350 ml; day: 200 ml versus 290 ml). CONCLUSIONS: Bothersome nocturia in postmenopausal women is associated with changes to both nocturnal diuresis and bladder storage. Regular physical activity, prolapse reduction and oestrogen replacement may be adjunctive in managing bothersome nocturia in women.
Subject(s)
Nocturia , Cross-Sectional Studies , Female , Humans , Nocturia/diagnosis , Nocturia/epidemiology , Nocturia/etiology , Polyuria/diagnosis , Polyuria/etiology , Urinary Bladder , UrinationABSTRACT
Classic distal renal tubular acidosis (dRTA) is characterized by inability to acidify the urine maximally (to Subject(s)
Acidosis, Renal Tubular/diagnosis
, Diabetes Insipidus, Nephrogenic/etiology
, Hypernatremia
, Hypokalemia/etiology
, Sjogren's Syndrome/complications
, Acidosis, Renal Tubular/etiology
, Adult
, Diabetes Insipidus, Nephrogenic/diagnosis
, Female
, Humans
, Hypokalemia/diagnosis
, Hypokalemia/drug therapy
, Muscle Weakness/etiology
, Paralysis/etiology
, Polyuria/diagnosis
, Polyuria/etiology
, Potassium/blood
, Sjogren's Syndrome/diagnosis
, Sjogren's Syndrome/drug therapy
ABSTRACT
AIM: Gitelman syndrome (GS) is a rare inherited salt-losing renal tubulopathy. Data on clinical features and the pregnancy outcome for female GS patients in a large cohort are lacking. The study was aimed to explore the phenotype and pregnant issue for female GS patients. METHODS: GS cases from the National Rare Diseases Registry System of China (NRSC) were collected, and detailed clinical, laboratory and genetic data were analysed. Articles on pregnancy in GS were also systemically reviewed. RESULTS: A total of 101 GS patients were included; among them, 42.6% were female and 79.2% showed hypomagnesaemia. A lower proportion of female patients presented before 18 years of age, with less frequently reported polyuria, higher serum potassium and less urine sodium and chloride excretions. There was no gender difference in the sodium-chloride cotransporter (NCC) dysfunction evaluated by hydrochlorothiazide test. Twelve of the 43 female GS patients delivered after disease symptom onset, and their pregnancies were generally uneventful. As a group, pregnant GS patients had lower potassium levels in the first-trimester (P = .002) requiring higher potassium supplementation. After delivery, serum potassium (P = .02) and magnesium (P = .03) increased significantly. Both caesarean section and vaginal delivery were safe. CONCLUSION: Female GS patients may have a less severe phenotype with generally favourable outcomes of pregnancy. Intensive monitoring and increased potassium supplementation are necessary during pregnancy, especially in the first-trimester.
Subject(s)
Delivery, Obstetric , Gitelman Syndrome , Potassium , Pregnancy Complications , Solute Carrier Family 12, Member 3/genetics , Water-Electrolyte Imbalance , Adult , China/epidemiology , Chlorides/urine , Delivery, Obstetric/methods , Delivery, Obstetric/statistics & numerical data , Female , Gitelman Syndrome/epidemiology , Gitelman Syndrome/genetics , Gitelman Syndrome/physiopathology , Gitelman Syndrome/therapy , Humans , Infant, Newborn , Magnesium/blood , Male , Mutation , Polyuria/diagnosis , Polyuria/etiology , Potassium/blood , Potassium/therapeutic use , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Pregnancy Complications/physiopathology , Pregnancy Complications/therapy , Pregnancy Outcome/epidemiology , Renal Elimination/genetics , Sodium/urine , Solute Carrier Family 12, Member 3/metabolism , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/etiology , Water-Electrolyte Imbalance/therapy , Water-Electrolyte Imbalance/urineABSTRACT
An 8-year-old girl with recently diagnosed Systemic Lupus Erythematosus (SLE) (class 4 lupus nephritis with autoimmune hemolytic anemia) presented to the pediatric nephrology clinic with polyuria, tiredness and cramps; laboratory investigations revealed refractory hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria and hyperchloriuria. There was no history of diuretic administration. These features were consistent with the Gitelman syndrome. She required large doses of potassium and magnesium supplementation along with spironolactone, for normalization of the serum potassium and magnesium levels. Immunosuppressive therapy was continued with cyclophosphamide pulses administered on a monthly basis. The doses of potassium and magnesium supplements were tapered off over the next 6 months. The clinical exome sequencing was negative for any mutations in the SLC12A3 gene. An 'acquired' form of Gitelman syndrome has been reported earlier in association with Sjogren syndrome and systemic sclerosis. Though tubular disorders such as renal tubular acidosis have been reported in association with SLE, a Gitelman-like syndrome has not been reported earlier. This case adds Gitelman-like tubulopathy to the clinical spectrum of tubular disorders complicating SLE.
Subject(s)
Gitelman Syndrome/etiology , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/complications , Polyuria/diagnosis , Alkalosis/diagnosis , Child , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Female , Gitelman Syndrome/diagnosis , Gitelman Syndrome/drug therapy , Gitelman Syndrome/urine , Humans , Hypokalemia/diagnosis , Hypokalemia/drug therapy , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Kidney Tubules/pathology , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Lupus Nephritis/diagnosis , Lupus Nephritis/pathology , Magnesium/administration & dosage , Magnesium/therapeutic use , Mineralocorticoid Receptor Antagonists/administration & dosage , Mineralocorticoid Receptor Antagonists/therapeutic use , Polyuria/etiology , Potassium/administration & dosage , Potassium/therapeutic use , Remission Induction , Spironolactone/administration & dosage , Spironolactone/therapeutic useABSTRACT
Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Subject(s)
Coronary Artery Bypass/adverse effects , Diabetes Insipidus, Neurogenic/diagnosis , Postoperative Complications/diagnosis , Adult , Antidiuretic Agents/therapeutic use , Coronary Vessels , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus, Neurogenic/drug therapy , Diabetes Insipidus, Neurogenic/etiology , Humans , Hypothalamus/diagnostic imaging , Magnetic Resonance Imaging , Male , Pituitary Gland/diagnostic imaging , Polyuria/diagnosis , Polyuria/etiology , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Radionuclide ImagingABSTRACT
Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Subject(s)
Adult , Humans , Male , Antidiuretic Agents/therapeutic use , Coronary Artery Bypass/adverse effects , Coronary Vessels , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus, Neurogenic/diagnosis , Hypothalamus/diagnostic imaging , Magnetic Resonance Imaging , Pituitary Gland/diagnostic imaging , Polyuria/diagnosis , Postoperative Complications/diagnosisABSTRACT
Previously no alternative therapy approach has been made to ameliorate disturbed circadian arginine vasopressin rhythm (C-AVP-R) in multiple system atrophy (MSA). A 65-year-old man with MSA showed loss of C-AVP-R and nocturnal polyuria. We performed moxibustion at specific acupuncture points on the bladder and inside the feet, once a day, 3 times a week, for 6 months. After the treatment, his C-AVP-R appeared to be normal, and the nocturnal urine output decreased to 75% (p<0.01). Together with the previous studies, it seems possible that somatic warm stimulation by moxibustion in specific points might have facilitated AVP secretion in this patient.
Subject(s)
Arginine Vasopressin/blood , Complementary Therapies/methods , Moxibustion/methods , Multiple System Atrophy/therapy , Polyuria/therapy , Aged , Arginine Vasopressin/metabolism , Circadian Rhythm , Follow-Up Studies , Humans , Japan , Male , Multiple System Atrophy/diagnosis , Nocturnal Enuresis/diagnosis , Nocturnal Enuresis/therapy , Polyuria/diagnosis , Risk Assessment , Treatment OutcomeABSTRACT
We report the case of a 35-yr-old tetraplegic man who experienced increased water intake, constant thirst, and a copious amount of urine excretion after his spinal cord injury and in whom an intermittent catheterization program was unmanageable. Laboratory evaluation revealed low serum and urine osmolality, which were suggestive of psychogenic polydipsia, and hypokalemia, which might lead to polyuria with a compensatory polydipsia. His water intake was reduced with antidepressant therapy and potassium supplementation and normalized on the third month of the treatment. Physicians should be aware of the differential diagnosis of polyuria and polydipsia, which interfere with neurogenic bladder management in patients with spinal cord injury.
Subject(s)
Drinking , Polyuria/diagnosis , Quadriplegia/diagnosis , Spinal Cord Injuries/diagnosis , Water-Electrolyte Imbalance/diagnosis , Adult , Cervical Vertebrae , Diagnosis, Differential , Follow-Up Studies , Humans , Male , Polyuria/etiology , Quadriplegia/complications , Quadriplegia/rehabilitation , Risk Assessment , Severity of Illness Index , Spinal Cord Injuries/complications , Spinal Cord Injuries/rehabilitationABSTRACT
PROBLEMS OF THE PROSTATE: Benign hypertrophy of the prostate (BHP), when it occurs, is manifested by an obstruction or irritation related to overactivity of the bladder. The obstructive syndrome is defined by urodynamic tests. Urge incontinence and study of the pressure-flow ratio are the tests of choice. The functional handicap and impact on quality of life are assessed using the International Prostatism Symptoms Score (I-PSS). Efficient and fairly well tolerated medical treatment has reduced the indications for surgery. It relies on alpha-blockers, 5a-reductase inhibitors and phytotherapy. When indicated, the surgical treatment of choice is endoscopic resection of the prostate. Among the non-prostatic micturition disorders, urge micturition with, in extreme cases, incontinence are due to detrusor instability. This is of multifactor origin; enhanced by the local irritation or environmental factors, it usually occurs within a context of acute or chronic pathologies. Treatment is recommended with anticholinergic agents. New molecules have recently been launched, better tolerated than oxybutinine. Electrostimulation can be a good alternative in mentally normal patients. Micturition due to excess urine may be due to overactivity of the bladder, the major risk of which is acute urine retention. It can also be observed during neurological affections such as Parkinson's disease or during administration of certain drugs. Nocturnal polyuria is a frequent problem. However, simple hygiene and dietary measures and the control of certain concomitant diseases can usually relieve the symptoms. Medical treatment relies on desmopressine.
Subject(s)
Urination Disorders/etiology , Adult , Age Factors , Aged , Diagnosis, Differential , Family Practice , Humans , Male , Middle Aged , Polyuria/diagnosis , Polyuria/etiology , Polyuria/therapy , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/therapy , Urinary Bladder Neck Obstruction/diagnosis , Urinary Bladder Neck Obstruction/etiology , Urinary Bladder Neck Obstruction/therapy , Urinary Incontinence/diagnosis , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Urination Disorders/diagnosis , Urination Disorders/therapy , Urodynamics/physiologyABSTRACT
Following surgery for tumors in the hypophyseal or hypothalamic region, low serum Na level (hyponatremia) is sometimes noted and causes clinical manifestations. Therefore, on the care of patients within 1 to 2 weeks following operation for tumors in this region, stabilization of serum Na level is one of the most important problems.