Persistent large increase in urine output.
Excessive or abnormally large production or passage of
urine (>3 L per day in adults).
Micturition: in which there is passage of small amount of
urine with increased frequency.
Polyuria is due to free water excretion or due to excessive
Due to excretion of increased non absorbable solutes(such
as glucose) – SOLUTE DIURESIS
Urine output > 3 L per day
Urine osmolality > 300 msmol/L
Glycosuria is uncontrolled daibetes mellitus
High protein diet causing increase urea production and
Excessive sodium loss in cystic renal disease
Renal tubular demage
Bartter syndrome: excessive urinary potassium loss –
hypokalemia and hypotension.
Due to excretion of increased water(from a defect in ADH
production or renal responsiveness) – WATER DIURESIS
Urine output >3 L per day
Urine is dilute (<250 mosmol/ L)
Causes – polydipsia
Central diabetes insipidus ( central or nephrogenic).
Frequent passage of small volume of urine without an
increase in total volume
Renal : pyelonephritis
Ureter : stone
Bladder: cystitis and BPH
Gynecological: vaginitis and pregnancy
Psychological: depression and tension
Normal urinary protein excretion should be < 150 mg/day.
Abnormal proteinuria was defined as excretion of protein >
Heavy proteinuria > 1g/dl – indicate glomerular origin
Mild to moderate – tubular defect
Stresses – no renal disorder, 1g/d.
Causes: exercise, fever, severe hypertension, burns,
postoperative and acute alcohol abuse.
when a patient is standing but not when recumbent, benign
condition usually occurring below the age 30.
Defined as proteinuria without hematuria or reduction in
glomerular filtration rate (GRF)
In most cases, patient is asymptomatic
Urine sediment is unremarkable
Causes: diabetes mellitus and amyloidosis
From production of excessive amounts of filterable protein
Such bence – jones protein in multiple myeloma,
myoglobinuria in rhabdomyolysis.
From inability of damage tubule to reabsorb normally filtered
Causes: acute tubular necrosis, toxic injury, drug induced
Normal < 30 microgram / per minute.
Dipstick can detect – concentration is more than 100 mg/L.
Albumin excretion > 20 microgram / min or 30 -300 mg/24.
Indicator of diabetic nephropathy.
24- hour urinary proteins
> 3.5 g/24 h – nephrotic range
Measurement of urinary protein
trace between 15-30mg/dl
1+ 30-100 mg/dl
Albumin – creatinine ratio:
Ratio b/w urinary protein concentration and urinary
30 mg of albumin per gram of creatinine is considered
Proteinuria is associated with renal insufficiency
particularly if it is acute in onset.
Reducing proteinuria may also reduce progression of renal
Low protein diet
Treatment of underlying cause.
may be glomerular or non glomerular in origin
Post – streptococcal glomerulonephrititis
Non – glomerular causes:
Renal stone, interstitial nephritis
Extra – renal causes:
Ureter: stone and papiloma
Bladder: trauma, stone, hemorrhagic cystitis
urethra; trauma infection, tumors and stone
Non – glomeular in origin
In the absence of infection gross hematuria from a lower
urinary tract is most commonly.
Due to from transitional cell carcinoma of bladder.
Blood in start of voiding comes from urethra
Blood diffusely present through out the urine comes from
the bladder or above.
Blood only at the end of micturition suggest bleeding from
prostate or bladder base
Urine analysis: protienuria and cast suggest renal in origin
Urine culture and sensitivity, urine cytology, IVP,
ultrasound kidney, and ultra sound abdomen.
Condition which may mimic hematuria
Hemoglobinuria: urine gives a positive chemical test for
hemoglobine, but no red cells are detectable.
Myoglobinuria: no red cell are seen but chemical tests for
hemoglobin are positive. Myoglobin can bee distinguished
Acute intermittent porphyria: fresh urine appears normal
but on standing for some hours a dark red color develops.