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Diabetes Mellitus Urine Volume

Osmotic Polyuria: An Overlooked Mechanism In Diabetic Nephropathy

Osmotic Polyuria: An Overlooked Mechanism In Diabetic Nephropathy

Diabetic nephropathy is a common and severe complication that occurs in ∼40% of patients with a long-standing type II diabetes mellitus and in a lesser proportion of subjects with type I diabetes. It occurs usually concomitantly with other microvascular complications of diabetes such as diabetic retinopathy and/or neuropathy that let some scholars view diabetic nephropathy as one of several clinical syndromes resulting from diabetic injury to microvessels. Abnormal microalbuminuria has emerged as a clinical risk factor for renal failure in diabetic renal disease as well as for cardio-vascular disease in general and specifically in diabetes. These epidemiological observations together with the experimental recognition that glomerular visceral epithelial cells (podocytes) are an early target in diabetic renal injury have given rise to the view that diabetic nephropathy may, in fact, be initially and primarily a glomerular disease and tubulo-interstitial nephropathy may be secondary to glomerular proteinuria and/or ischaemia given that peritubular capillaries are located downstream of efferent arterioles. Clinical–pathological correlations have drawn attention that renal failure in diabetic nephropathy is more closely determined by tubulo-interstitial injury and fibrosis than by diabetic nodular and/or diffuse glomerular sclerosis [1,26]. Findings from experimental in vitro studies and in vivo observations in animal models have derived a series of hypotheses as to the mechanisms of tubulo-interstitial injury. Most of these invoke high glucose levels and the increased proportion of glycation of structural and regulatory cell proteins and extracellular proteins (such as glycated albumin and modified ultrafiltered proteins) at the initiation of an injury cascade. Response Continue reading >>

Why Does Diabetes Cause Excessive Urination And Thirst? A Lesson On Osmosis

Why Does Diabetes Cause Excessive Urination And Thirst? A Lesson On Osmosis

A TABA Seminar on Diabetes I have the pleasure of being an executive member of the Toronto Applied Biostatistics Association (TABA), a volunteer-run professional organization here in Toronto that organizes seminars on biostatistics. During this past Tuesday, Dr. Loren Grossman from the LMC Diabetes and Endocrinology Centre generously donated his time to deliver an introductory seminar on diabetes for biostatisticians. The Institute for Clinical and Evaluative Sciences (ICES) at Sunnybrook Hospital kindly hosted us and provided the venue for the seminar. As a chemist and a former pre-medical student who studied physiology, I really enjoyed this intellectual treat, especially since Loren was clear, informative, and very knowledgeable about the subject. Diabetes Diabetes is a group of metabolic diseases that are characterized by a high concentration of glucose in the bloodstream. Glucose is a common monomer of carbohydrates that exists in many foods, including bread, pasta, rice, fruits, vegetables, and refined sugar. It provides the fuel for the cells of our bodies to function. Chemical Structures of Open-Chain and Cyclic Glucose For a variety of reasons that distinguish the different types of diabetes, diabetics cannot absorb glucose normally, leaving an excess of glucose in the bloodstream. Diabetes leads to many health problems, like kidney failure, blindness, heart attacks and strokes. The Growing Prevalence of Diabetes It was interesting but sad for me to learn about the increased prevalence of diabetes in North America and around the world. Loren commented that diabetes was a specialized niche area in endocrinology when he began his research in this field over 25 years ago, but it is now a major area of study in medical research because of its epidemic proportions. Continue reading >>

Excessive Urination Volume (polyuria)

Excessive Urination Volume (polyuria)

Excessive urination volume (or polyuria) occurs when you urinate more than normal. Urine volume is considered excessive if it equals more than 2.5 liters per day. A “normal” urine volume depends on your age and gender. However, less than 2 liters per day is usually considered normal. Excreting excessive volumes of urine is a common condition but should not last more than several days. Many people notice the symptom at night. In this case, it is called nocturnal polyuria (or nocturia). Excessive urine output can sometimes signal health problems, including: bladder infection (common in children and women) urinary incontinence interstitial nephritis kidney failure psychogenic polydipsia, a mental disorder causing excessive thirst enlarged prostate, also known as benign prostatic hyperplasia (most common in men over 50 years old) certain kinds of cancer You may also notice polyuria after a CT scan or any other hospital test in which a dye is injected into your body. Excessive urine volume is common the day after the test. Call your doctor if the problem continues. Excessive urine volume often occurs due to lifestyle behaviors. This can include drinking large amounts of liquid, which is known as polydipsia and isn’t a serious health concern. Drinking alcohol and caffeine can also lead to polyuria. Certain medications, such as diuretics, increase urine volume. Talk to your doctor if you recently started a new medication (or just changed your dosage) and notice changes in your urine volume. Both alcohol and caffeine are diuretics, and some medications for high blood pressure and edema also act as diuretics, including: You may experience polyuria as a side effect of these medications. Seek treatment for polyuria if you think a health issue is the cause. Certain symptoms s Continue reading >>

Influence Of First Morning Urine Volume, Fasting Blood Glucose And Glycosylated Hemoglobin On First Morning Urinary Albumin Concentration

Influence Of First Morning Urine Volume, Fasting Blood Glucose And Glycosylated Hemoglobin On First Morning Urinary Albumin Concentration

PrintversionISSN 0100-879XOn-lineversionISSN 1414-431X Braz J Med Biol Resvol. 30no. 2Ribeiro PretoFeb.1997 Braz J Med Biol Res, February 1997, Volume 30(2) 191-196 Influence of first morning urine volume, fasting blood glucose and glycosylated hemoglobin on first morning urinary albumin concentration M.B. Gomes, M.R. Lucchetti, M.F.R. Gonalves, H. Gazzolla, T. Dimetz and H. Matos Disciplina de Diabetes e Metabologia, Universidade do Estado do Rio de Janeiro, 20551-030 Rio de Janeiro, RJ, Brasil The aim of the present study was to evaluate the effect of first morning urinary volume (collected on three different non-consecutive days), fasting blood glucose (determined on the first and third days of urine collection), and glycosylated hemoglobin (determined on the first and third days of urine collection) on the albumin concentration in first morning urine samples collected on three different days. We found 3.6% asymptomatic bacteriuria in the urine samples; therefore, every urine sample must be tested to exclude infection. One hundred and fifty urine samples were provided by 50 IDDM patients aged 21.9 7 (12-38) years with a disease duration of 6.8 5.8 (0.4-31) years attending the Diabetes Clinic at the State University Hospital of Rio de Janeiro. There were no differences in albumin concentration (6.1 vs 5.8 vs 6.2 g/ml; P = NS) or urinary volume (222.5 vs 210 vs 200 ml) between the three samples. In addition, there were no differences in fasting blood glucose (181.9 93.6 vs 194.6 104.7 mg%; P = NS) or glycosylated hemoglobin (HbA1) (8.4 1.3 vs 8.8 1.5%; P = NS) between the first and third blood samples. Six patients (group 1) had a mean urinary albumin concentration of more than 20 g/ml for the three urine samples. This group was compared with the 44 patients (group 2) Continue reading >>

Polyuria

Polyuria

Not to be confused with polyurea or pollakiuria. Polyuria (/ˌpɒliˈjʊəriə/) is excessive or an abnormally large production or passage of urine (greater than 2.5[1] or 3[2] L over 24 hours in adults). Frequent urination is usually an accompanying symptom. Increased production and passage of urine may also be termed diuresis.[3][4] Polyuria often appears in conjunction with polydipsia (increased thirst), though it is possible to have one without the other, and the latter may be a cause or an effect. Psychogenic polydipsia may lead to polyuria. [5] Polyuria is usually viewed as a symptom or sign of another disorder (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.[citation needed] Causes[edit] The most common cause of polyuria in both adults and children is uncontrolled diabetes mellitus,[2] which causes osmotic diuresis, when glucose levels are so high that glucose is excreted in the urine. Water follows the glucose concentration passively, leading to abnormally high urine output. In the absence of diabetes mellitus, the most common causes are decreased secretion of aldosterone due to adrenal cortical tumor, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus.[2] Polyuria may also be due to various chemical substances, such as diuretics, caffeine, and ethanol. It may also occur after supraventricular tachycardias, during an onset of atrial fibrillation, childbirth, and the removal of an obstruction within the urinary tract. Diuresis is controlled by antidiuretics such as vasopressin, angiotensin II and aldosterone. Cold diuresis is the occurrence of increased urine production on exposure to cold, which also partially explains immersion diuresis. H Continue reading >>

Diabetes Mellitus And Polyuria

Diabetes Mellitus And Polyuria

Diabetes comes from the Greek word which means “siphon”. There are two distinct disorders that share the first name diabetes: diabetes mellitus and diabetes insipidus. This is because both disorders cause polyuria, or excessive urine output. Diabetes insipidus is a disorder of urine concentration which we will discuss in spring quarter. Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is hyperglycemia, or high levels of glucose in the plasma. How does hyperglycemia cause excessive urine production? To answer this, we need to understand a little bit about how the kidney works. Each kidney contains about a million functional units called nephrons (blue structure in the figure). The first step in the production of urine is a process called filtration (green arrow). In filtration, there is bulk flow of water and small molecules from the plasma into Bowman’s capsule (the first part of the nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the loss of these useful substances from the body, the cells lining the kidney tubules use epithelial transport to transfer these substances out of the forming urine and back into the extracellular fluid. This process is known as reabsorption (purple arrows). Under normal circumstances, 100% of the glucose that is filtered is Continue reading >>

Diabetes Symptoms: When Diabetes Symptoms Are A Concern

Diabetes Symptoms: When Diabetes Symptoms Are A Concern

Diabetes symptoms are often subtle. Here's what to look for — and when to consult your doctor. Early symptoms of diabetes, especially type 2 diabetes, can be subtle or seemingly harmless — that is, if you even have symptoms at all. Over time, however, you may develop diabetes complications, even if you haven't had diabetes symptoms. In the United States alone, more than 8 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don't need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health. If you're experiencing any of the following diabetes signs and symptoms, see your doctor. Excessive thirst and increased urination Excessive thirst (also called polydipsia) and increased urination (also known as polyuria) are classic diabetes symptoms. When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more. Fatigue You may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body's inability to function properly, since it's less able to use sugar for energy needs. Weight loss Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells — leading to constant Continue reading >>

Polyuria - Frequent Urination

Polyuria - Frequent Urination

Tweet Polyuria is a condition where the body urinates more than usual and passes excessive or abnormally large amounts of urine each time you urinate. Polyuria is defined as the frequent passage of large volumes of urine - more than 3 litres a day compared to the normal daily urine output in adults of about one to two litres. It is one of the main symptoms of diabetes (both type 1 and type 2 diabetes) and can lead to severe dehydration, which if left untreated can affect kidney function. Causes of polyuria Polyuria is usually the result of drinking excessive amounts of fluids (polydipsia), particularly water and fluids that contain caffeine or alcohol. It is also one of the major signs of diabetes mellitus. When the kidneys filter blood to make urine, they reabsorb all of the sugar, returning it to the bloodstream. In diabetes, the level of sugar in the blood is abnormally high. Not all of the sugar can be reabsorbed and some of this excess glucose from the blood ends up in the urine where it draws more water. This results in unusually large volumes of urine. Other causes of polyuria include: Diabetes inspidus - a condition unrelated to diabetes mellitus that affects the kidneys and the hormones that interact with them, resulting in large quantities of urine being produced. Kidney disease Liver failure Medications that include diuretics (substances that increase the excretion of water from the body/urine) Chronic diarrhoea Cushing’s syndrome Psychogenic polydipsia - excessive water drinking most often seen in anxious, middle-aged women and in patients with psychiatric illnesses Hypercalcemia - elevated levels of calcium in the blood Pregnancy Polyuria as a symptom of diabetes As well as being one of the symptoms of undiagnosed diabetes, polyuria can also occur in peop Continue reading >>

Urine Output In Diabetes Insipidus

Urine Output In Diabetes Insipidus

INTRODUCTION Diabetes insipidus (DI) is a disorder in which polyuria due to decreased collecting tubule water reabsorption is induced by either decreased secretion of antidiuretic hormone (ADH) (central DI) or resistance to its renal effects (nephrogenic DI). In most patients, the degree of polyuria is primarily determined by the degree of ADH deficiency or resistance [1]. Thus, the urine output may range from 2 L/day with mild partial DI to over 10 to 15 L/day in patients with severe disease. Determinants of the urine output in patients with DI will be discussed here. The diagnosis of DI and the causes and treatment of central and nephrogenic DI are presented elsewhere. (See "Diagnosis of polyuria and diabetes insipidus" and "Clinical manifestations and causes of central diabetes insipidus" and "Clinical manifestations and causes of nephrogenic diabetes insipidus" and "Treatment of central diabetes insipidus" and "Treatment of nephrogenic diabetes insipidus".) DETERMINANTS OF URINE OUTPUT The determinants of the urine output differ in normal subjects and those with diabetes insipidus (DI). The urine output in normals primarily reflects water intake, which leads to alterations in the plasma osmolality that are sensed by the osmoreceptors in the hypothalamus that regulate both antidiuretic hormone (ADH) release and thirst [2,3]. In addition to central osmoreceptors, peripheral osmoreceptor neurons that innervate hepatic blood vessels detect osmotic shifts in portal blood and modulate ADH release [4]. (See "General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema)", section on 'Regulation of plasma tonicity'.) Normally, an increase in water intake sequentially lowers the plasma osmolality, decreases ADH se Continue reading >>

Physical Characteristics Of Urine

Physical Characteristics Of Urine

By the end of this section, you will be able to: Compare and contrast blood plasma, glomerular filtrate, and urine characteristics Describe the characteristics of a normal urine sample, including normal range of pH, osmolarity, and volume The urinary systems ability to filter the blood resides in about 2 to 3 million tufts of specialized capillariesthe glomerulidistributed more or less equally between the two kidneys. Because the glomeruli filter the blood based mostly on particle size, large elements like blood cells, platelets, antibodies, and albumen are excluded. The glomerulus is the first part of the nephron, which then continues as a highly specialized tubular structure responsible for creating the final urine composition. All other solutes, such as ions, amino acids, vitamins, and wastes, are filtered to create a filtrate composition very similar to plasma. The glomeruli create about 200 liters (189 quarts) of this filtrate every day, yet you excrete less than two liters of waste you call urine. Characteristics of the urine change, depending on influences such as water intake, exercise, environmental temperature, nutrient intake, and other factors (See Table 1). Some of the characteristics such as color and odor are rough descriptors of your state of hydration. For example, if you exercise or work outside, and sweat a great deal, your urine will turn darker and produce a slight odor, even if you drink plenty of water. Athletes are often advised to consume water until their urine is clear. This is good advice; however, it takes time for the kidneys to process body fluids and store it in the bladder. Another way of looking at this is that the quality of the urine produced is an average over the time it takes to make that urine. Producing clear urine may take only Continue reading >>

Urination - Excessive Amount

Urination - Excessive Amount

An excessive volume of urination for an adult is more than 2.5 liters of urine per day. However, this can vary depending on how much water you drink and what your total body water is. This problem is different from needing to urinate often. Polyuria is a fairly common symptom. People often notice the problem when they have to get up during the night to use the bathroom (nocturia). Some common causes of the problems are: Less common causes include: Also, your urine production may increase for 24 hours after having tests that involve injecting a special dye (contrast medium) into your vein during imaging tests such as a CT scan or an MRI scan. Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Print Overview Diabetes insipidus (die-uh-BEE-teze in-SIP-uh-dus) is an uncommon disorder that causes an imbalance of water in the body. This imbalance leads to intense thirst even after drinking fluids (polydipsia), and excretion of large amounts of urine (polyuria). While the names diabetes insipidus and diabetes mellitus sound similar, they're not related. Diabetes mellitus — which can occur as type 1 or type 2 — is the more common form of diabetes. There's no cure for diabetes insipidus, but treatments are available to relieve your thirst and normalize your urine output. Symptoms The most common signs and symptoms of diabetes insipidus are: Extreme thirst Excretion of an excessive amount of diluted urine Depending on the severity of the condition, urine output can be as much as 16 quarts (about 15 liters) a day if you're drinking a lot of fluids. Normally, a healthy adult will urinate an average of less than 3 quarts (about 3 liters) a day. Other signs may include needing to get up at night to urinate (nocturia) and bed-wetting. Infants and young children who have diabetes insipidus may have the following signs and symptoms: Unexplained fussiness or inconsolable crying Trouble sleeping Fever Vomiting Diarrhea Delayed growth Weight loss When to see a doctor See your doctor immediately if you notice the two most common signs of diabetes insipidus: excessive urination and extreme thirst. Causes Diabetes insipidus occurs when your body can't regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This fluid waste is temporarily stored in your bladder as urine, before you urinate. When your fluid regulation system is working properly, your kidneys conserve fluid and make less urine when your body water is decreased, suc Continue reading >>

25.1 Physical Characteristics Of Urine Anatomy And Physiology

25.1 Physical Characteristics Of Urine Anatomy And Physiology

By the end of this section, you will be able to: Compare and contrast blood plasma, glomerular filtrate, and urine characteristics Describe the characteristics of a normal urine sample, including normal range of pH, osmolarity, and volume The urinary systems ability to filter the blood resides in about 2 to 3 million tufts of specialized capillariesthe glomerulidistributed more or less equally between the two kidneys. Because the glomeruli filter the blood based mostly on particle size, large elements like blood cells, platelets, antibodies, and albumen are excluded. The glomerulus is the first part of the nephron, which then continues as a highly specialized tubular structure responsible for creating the final urine composition. All other solutes, such as ions, amino acids, vitamins, and wastes, are filtered to create a filtrate composition very similar to plasma. The glomeruli create about 200 liters (189 quarts) of this filtrate every day, yet you excrete less than two liters of waste you call urine. Characteristics of the urine change, depending on influences such as water intake, exercise, environmental temperature, nutrient intake, and other factors ( Table 1 ). Some of the characteristics such as color and odor are rough descriptors of your state of hydration. For example, if you exercise or work outside, and sweat a great deal, your urine will turn darker and produce a slight odor, even if you drink plenty of water. Athletes are often advised to consume water until their urine is clear. This is good advice; however, it takes time for the kidneys to process body fluids and store it in the bladder. Another way of looking at this is that the quality of the urine produced is an average over the time it takes to make that urine. Producing clear urine may take only a Continue reading >>

Difference In 24-hour Urine Composition Between Diabetic And Non-diabetic Adults Without Nephrolithiasis

Difference In 24-hour Urine Composition Between Diabetic And Non-diabetic Adults Without Nephrolithiasis

Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis Wei Zhu ,#1,2 Zanlin Mai ,#1,2 Jing Qin ,1,2 Xiaolu Duan ,1,2 Yang Liu ,1,2 Zhijian Zhao ,1,2 Jian Yuan ,1,2 Shaw P. Wan ,1,2 and Guohua Zeng 1,2,* 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China 1Department of Urology, Minimally Continue reading >>

Why Does Diabetes Make You Urinate So Much?

Why Does Diabetes Make You Urinate So Much?

More than 29 million Americans have diabetes, but more than a quarter of them don’t know it. Frequent urination may be one of the first signs that you have high blood sugar, a hallmark sign of diabetes. When you have diabetes, your body is unable to regulate blood sugar levels. Excess sugar causes more fluids to pass through the kidneys and increases urinary frequency, known as polyuria. “There are other reasons that people with type 2 diabetes can have increased urinary frequency and incontinence,” says Noah Bloomgarden, MD, assistant professor of medicine-endocrinology at the Albert Einstein College of Medicine and clinical endocrinologist in the division of endocrinology, diabetes, and metabolism at the Montefiore Health System in the Bronx, New York. “But the most common cause is hyperglycemia [high blood sugar], or uncontrolled diabetes.” Polyuria is not as serious as many other complications commonly associated with diabetes, such as blindness, heart disease, stroke, kidney failure, amputation, and premature death. But it can be a sign that your blood sugar is elevated, so it’s something you should address with your doctor. Frequent urination is not the only bladder problem that occurs in people with diabetes. They may experience a frequent urge to urinate (even if only a small amount of urine comes out), a loss of bladder control that results in leaking urine, and urinary tract or fungal infections. Such infections can also lead to an increase in urinary frequency and incontinence, especially in the elderly. “It really depends on the point a person is at in developing diabetes, and what level of [blood sugar] control they have,” says Dr. Bloomgarden. If diabetes goes untreated or if it has been poorly controlled for a long time, you can develop se Continue reading >>

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