MP80-05 NOCTURNAL POLYURIA IN PATIENTS WITH A SPINAL CORD LESION - IS IT DIFFERENT OR NOT?

Field: Medicine (Health Sciences)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 2014MP80-05 NOCTURNAL POLYURIA IN PATIENTS WITH A SPINAL CORD LESION - IS IT DIFFERENT OR NOT? Marie-Astrid Denys, Annick Viaene, An-Sofie Goessaert, and Karel Everaert Marie-Astrid DenysMarie-Astrid Denys More articles by this author , Annick ViaeneAnnick Viaene More articles by this author , An-Sofie GoessaertAn-Sofie Goessaert More articles by this author , and Karel EveraertKarel Everaert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2528AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is commonly observed that patients with spinal cord lesions have nocturnal polyuria (NP), which gives rise to complications (autonomic hyperreflexia, urinary tract infections, hydronephrosis, ...) and affects quality of life. First, it is considered that the circadian rhythmicity in the secretion of vasopressin is disturbed, which leads to an increased water diuresis. Second, it is known that these patients experience more fluid retention, which returns in the intravascular space when they lie down. This influences the secretion of natriuretic hormones, which contributes to an increased solute diuresis. The objective of this study was to evaluate circadian rhythms of renal functions in adults with spinal cord lesions compared to a control population, both with and without NP. METHODS Twenty-three adults with a spinal cord lesion and NP were compared to 93 controls; 61 with NP and 32 without NP. All participants were younger than 65 years. The study protocol comprised a 24h urine collection, in which 8 urine samples with an interval of 3h between each sample had to be collected to determine urine volume and the levels of creatinine and osmolality excretion. The last 3 samples (12-2am, 3-5am, 6-8am) were considered as nighttime samples. RESULTS The mean age in the 23 cases, 61 controls with NP and 32 controls without NP was 45±13.5, 49±14.1 and 43±13.0 years, respectively. Controls without NP showed a circadian rhythm, with lower diuresis rate, increased osmolality and decreased solute excretion during nighttime. A decrease in nocturnal osmolality was observed in the controls with NP, which pleads for a vasopressin disturbance. The cases also showed an inversed circadian rhythm in osmolality excretion. In addition, they also had higher values for nocturnal solute diuresis. Because 2 pathophysiologic mechanisms contribute to the development of NP in the cases, this has to be taken into account when initiating treatment. Desmopressin should be considered in order to correct the disturbed water diuresis and daytime furosemide to reduce nocturnal solute diuresis. CONCLUSIONS Nocturnal polyuria in patients with spinal cord lesions is caused by a disturbed water and solute diuresis. Consequently, treatment should be directed to both pathophysiologic mechanisms and a combination of desmopressin and furosemide should be considered. Table 1. Patient characteristics and circadian rhythm of renal functions (NP=nocturnal polyuria=nocturnal urine production >0,9ml/min) Cases (N=23) (mean±SD) Controls with NP (N=61) (mean±SD) Controls without NP (N=32) (mean±SD) Cases vs. controls with NP (P-value) Cases vs. controls without NP (P-value) Age (years) 45±13,5 49±14,1 43±13,0 0,203 0,527 Gender (male/female) 15/8 36/25 6/26 0,609 0,000† Day Night Day Night Day Night Day Night Day Night Diuresis rate (ml/min) 1,4±0,72 1,8±0,91° 1,7±0,76 1,6±0,56 1,3±0,59 0,7±0,17† 0,141 0,181 0,603 0,000† Osmolality (mosm/kg) 475±156,0 414±163,2° 543±191,0 488±164,2° 643±223,1 742±163,9† 0,134 0,069 0,000† 0,000† Solute excretion (mosm/kg)/(mg/dl creatinine) 7,7±2,83 7,7±3,88 6,7±1,171 6,3±1,64 6,5±1,24 5,1±1,38† 0,045° 0,025° 0,003° 0,000† ° p<0.05 † p=0.000 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e939 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marie-Astrid Denys More articles by this author Annick Viaene More articles by this author An-Sofie Goessaert More articles by this author Karel Everaert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...