This document discusses polyuria, which is excessive urine output of greater than 3 liters per day in adults. Polyuria can be caused by physiological factors like excessive fluid intake or anxiety, or pathological factors like endocrine, renal, or psychiatric conditions. It may occur due to increased solute excretion (solute diuresis) or increased water excretion due to a defect in ADH production or renal responsiveness (water diuresis). Other conditions discussed include proteinuria, hematuria, and urinary retention. Causes, diagnostic testing, and treatment approaches are provided for each condition.

1. Yousaf Khan
Renal Dialysis Lecturer
IPMS, KMU

2.  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
solute excretion.

3. Physiological
 Excessive intake of fluid
 Cold climate
 Anxiety
 Pro rich diet
Pathological
 Endocrine
 Renal
 Systemic
 Psychiatric
 Drugs
 Iatrogenic

4.  Due to excretion of increased non absorbable solutes(such
as glucose) – SOLUTE DIURESIS
 Urine output > 3 L per day
 Urine osmolality > 300 msmol/L
Causes:
 Glycosuria is uncontrolled daibetes mellitus
 Mannitol administration
 High protein diet causing increase urea production and
excretion.
 Excessive sodium loss in cystic renal disease
 Renal tubular demage
 Bartter syndrome: excessive urinary potassium loss –
hypokalemia and hypotension.

5.  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).

6.  Frequent passage of small volume of urine without an
increase in total volume
 Causes:
 Renal : pyelonephritis
 Ureter : stone
 Bladder: cystitis and BPH
 Urethera: urethitis
 Gynecological: vaginitis and pregnancy
 Psychological: depression and tension

7.  Normal urinary protein excretion should be < 150 mg/day.
 Abnormal proteinuria was defined as excretion of protein >
150 mg/day.
 Heavy proteinuria > 1g/dl – indicate glomerular origin
 Mild to moderate – tubular defect

8. Primary renal disease
 Glomerulonephritis
Secondary Renal disease
 Systemic disease : diabetes, hypertension and amyloidosis
 Drugs: captopril, penicillamine, heroin and NSAID
 Infection: Hepatitis B, infective endocarditis, malaria, AIDS
 Allergy: Vaccine, bee sting

9. Functional proteinuria:
 Stresses – no renal disorder, 1g/d.
 Causes: exercise, fever, severe hypertension, burns,
postoperative and acute alcohol abuse.
Orthostatic proteinuria:
 when a patient is standing but not when recumbent, benign
condition usually occurring below the age 30.
Isolated proteinuria:
 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

10. Overload proteinuria:
 From production of excessive amounts of filterable protein
 Such bence – jones protein in multiple myeloma,
myoglobinuria in rhabdomyolysis.
Tubular proteinuria:
 From inability of damage tubule to reabsorb normally filtered
proteins.
 Causes: acute tubular necrosis, toxic injury, drug induced
interstitial nephrititis,
Microalbuminuria
 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.

11. 24- hour urinary proteins
 > 3.5 g/24 h – nephrotic range
Measurement of urinary protein
Urine dipstick
negative
trace between 15-30mg/dl
1+ 30-100 mg/dl
2+ 100-300mg/dl
3+ 300-1000mg/dl
4+ >1000mg/dl

12. Albumin – creatinine ratio:
 Ratio b/w urinary protein concentration and urinary
creatinine concentration.
 30 mg of albumin per gram of creatinine is considered
abnormal
Renal Biopsy:
 Proteinuria is associated with renal insufficiency
particularly if it is acute in onset.

13.  Reducing proteinuria may also reduce progression of renal
disease
 Low protein diet
 Treatment of underlying cause.

14. Causes:
 Renal causes
may be glomerular or non glomerular in origin
Glomerular causes:
 IgA nephropathy
 Nephritic syndorm
 Post – streptococcal glomerulonephrititis
 Membranoproliferative glomerulonephrititis
Non – glomerular causes:
 Renal cyste
 Renal stone, interstitial nephritis
 Renal tumors

15.  Extra – renal causes:
 Ureter: stone and papiloma
 Bladder: trauma, stone, hemorrhagic cystitis
 urethra; trauma infection, tumors and stone
 Blood disorder
Drugs:
 Anticoagulants
 Analgesic abuse
 Cyclophosphomide
 antibiotics

16.  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

17.  Glomerulonephritis
 Renal T.B
 Collagen disease e.g SLE
 Malignant hypertension
 Blood disorder
 Infective endocarditis
 Benign prostatichyperplasia

18.  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
by spectrometry.
 Acute intermittent porphyria: fresh urine appears normal
but on standing for some hours a dark red color develops.

19. The inability to voluntarily void urine

20.  Obstructive
 Infectious & Inflammatory
 Pharmacologic
 Neurologic
 Other

21.  Benign prostatic hyperplasia
 Strictures
 Bladder calculi
 Faecal Impactation
 Phimosis
 Benign/malignant pelvic masses
 Organ prolapse
 Pelvic mass – gynae malignancy
 Uterine fibroid / ovarian cyst
 Foreign bodies

22.  Prostatitis
 Prostatic abscess
 Cystitis
 Acute vaginitis
 Herpes simplex virus

23.  Drugs with anticholingeric properties eg:
tricylic antidepressants (amitriptyline)
 Opioids
 NSAIDs in men
 Antiparkinsonian agents (levodopa)
 Antipsychotics (chlopromazine)
 Muscle relaxants (Baclofen)

24. AUTONOMIC OR PERIPHERAL NERVE
 Diabetes mellitus,
BRAIN
 Tumour, Parkinson’s disease,
SPINAL CORD
 Haematoma / abscess

25.  Post-op complications
 Pregnancy-associated retention
 Trauma eg: penile fracture or laceration
 Idiopathic detrusor failure

26. Thank you