Nocturnal polyuria

It is «the production of an abnormally large volume of urine during sleep, is the most important cause of nocturia and commonly defined as a nocturnal urine volume >33% of 24-hour urine volume in elderly patients or >20% in young patients [1].» «Nocturnal polyuria has to be suspected in patients with high-frequency and high-volume urine output that is excessive only at night [1,2].»

«Causes of nocturnal polyuria include a decrease in nocturnal urinary levels of arginine-vasopressin, an increase in atrial natriuretic peptide (e.g. patients with congestive heart failure, obstructive sleep apnoea), peripheral oedema (e.g. patients with venous insufficiency, congestive heart failure, liver failure, chronic kidney disease, nephrotic syndrome), excessive evening/nocturnal fluid intake, use of diuretics (at evening) [1,3].» «Uncontrolled diabetes insipidus/mellitus are potential causes of global polyuria [1,3].»

«Desmopressin (an antidiuretic) may be prescribed to decrease nocturia due to idiopathic nocturnal polyuria in men/women under the age of 65 [1,4]. A newer low-dose, gender-specific formulation of desmopressin is available and not limited to patients under the age of 65 [1,5].» «Antimuscarincs/α-blockers may be offered to men with nocturia associated with (storage) OAB (overactive bladder)/LUTS (lower urinary tract symptoms) [1,4]. However, therapies for OAB/LUTS do not treat nocturia due to nocturnal polyuria [1].» «If nocturia is suspected to be caused by a non-urological condition, the treating physician should consider to refer the patient to a specialist (offer shared care) [1,4].» «However, it should be noted that a first step in the management of nocturia consists of lifestyle modifications  (e.g. avoidance of caffeinated, alcoholic or carbonated beverages in the evening, reduced fluid intake in the evening, bladder emptying before going to be, weight loss) [1,4].

Bibliographic references:

[1] Pinpoint cases - Initial management of nocturia. Mirrors of medicine - PinPoint Cases. https://ppcp.mirrorsmed.org/case/cdombry4m54cg8c4kgws8ks0cs0c08k. Accessed December 16, 2018.

[2] Rees J, et al. Practical approaches to diagnosis and management of nocturia. Trends in Urology & Men's Health. March/April 2018. Available at https://wileymicrositebuilder.com/trends/wp-content/uploads/sites/13/2018/03/Nocturia_v2-lsw.pdf.

[3] Dani H, et al. Nocturia: aetiology and treatment in adults. Nat Rev Urol 2016;13:573-83. Available at: https://doi.org/10.1038/nrurol.2016.134.

[4] Gravas S, et al. EAU 2018 guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-the-Management-of-Non-neurogenic-Male-LUTS-2018-large-text.pdf.

[5] Juul KV, et al. Low-dose desmopressin combined with serum sodium monitoring can prevent clinically significant hyponatraemia in patients treated for nocturia. BJU Int 2017;119:776-84. Available at: https://doi.org/10.1111/bju.13718.