The humble "night up" revealed the kidneys' distress signals, and 16 expert opinions were beneficial for the early prevention and treatment of CKD

Guide

Nocturnal polyuria is defined as urinating more than 20% (young people) or 33% (older people) during the main sleep time, or excessive urine excretion within 24 hours (> 40 ml/kg/day). Polyuria at night and frequent night ups can affect the patient's sleep and quality of life. Studies have shown that chronic kidney disease (CKD), endocrine dysfunction, cardiovascular disease, and individual behavior can all lead to nocturnal polyuria.

On 11 January 2022, the UK Primary Care Assessment and Treatment Team released a consensus of experts to draw the attention of clinicians to nocturia. They believe that nocturnal polyuria can help doctors understand the progression of CKD and have some benefits for CKD prevention and treatment. This recommendation covers the mechanisms, evaluation, and treatment of nocturnal polyuria.

mechanism

1. Some patients with nocturnal hypertension may have a condition of pressure-diuretic sodium, which will lead to increased urination;

2. Liquid and salt retention. In healthy people, excess water and salt are excreted while awake, but CKD may dull this response, leading to increased compensatory urination at night. In addition, the redistribution of residual fluids can also explain increased nocturnal urination, which is more likely to occur in patients with advanced CKD;

3. Patients with CKD may be insensitive to antidiuretic hormone (ADH), which can lead to an increase in urine output at 24 hours. In addition, it is also possible that patients with insufficient secretion of ADH at night, leading to nocturnal polyuria;

4. CKD can cause loss of renal hypertonic medulla, resulting in 24h polyuria;

5. Inherited or acquired tubular sodium reabsorption defects (eg, Bart syndrome) and proximal tubular disease (eg, Fanconi syndrome) may cause polyuria for 24 hours;

6. The following 4 drugs may also cause polyuria for 24h or polyuria at night:

(1) Diuretics, depending on the type, time of administration and dosage;

(2) Lithium salt drugs can cause renal diabetes insipidus, because lithium salts can cause ADH receptor insensitivity;

(3) Some antihypertensive drugs can cause edema or fluid retention, such as calcium channel blockers (amlodipine);

(4) Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause tubular interstitial damage, resulting in polyuria at 24h or polyuria at night.

assess

1. A detailed understanding of the medical history, including whether the patient is thirsty, the amount of water she drinks (intake, time, type), and the amount of urine;

2. Check the medication history, especially the type and time of use of diuretics, lithium salts, calcium channel blockers and NSAIDs;

3. Check whether the patient has edema, especially edema without obvious clinical manifestations;

4. Blood pressure assessment;

5. Urine test, including urine protein creatinine ratio (ACR) and hematuria;

6. Blood tests, including blood urea, serum creatinine, estimation of glomerular filtration rate (eGFR). If subclinical edema is suspected, N-terminal B-type natriuretic peptideogen (NT-proBNP) should be checked, and if NT-proBNP is elevated, heart failure should be managed;

7. Renal ultrasound.

intervene

1. Dietary interventions, including reducing salt intake, supplementing fluids appropriately, and avoiding caffeine or alcohol at night;

2. Adjust the prescription, check whether the drug used by the patient is related to the increase in urine output or nocturia at 24 hours, if there is a need to adjust the prescription, multidisciplinary consultation may be required;

3. Hypertension management, if blood pressure rises, the treatment strategy should be evaluated in time. In addition, for patients who have already taken antihypertensive drugs, dosing at bedtime is a reasonable strategy.

Nocturia, or nocturnal polyuria, is common in patients with CKD, but other conditions, such as cardiovascular disease and diabetes, can also affect kidney function. Therefore, the possibility of other disorders should be considered and evaluated before attributing nocturia to CKD. However, nocturia can detect patients with CKD or renal dysfunction in time. Early detection and early intervention can reduce the risk of CKD occurrence, progression, and death. In general, nocturia should not be ignored and should be taken seriously by nephrologists as well as by general practitioners.

Submission Email: [email protected]

Typography: Don

bibliography:

1.RidgwayA, Cotterill N, Dawson S, et al. Nocturia and Chronic Kidney Disease:Systematic Review and Nominal Group Technique Consensus on Primary CareAssessment and Treatment. Eur Urol Focus. 2022 Jan 11:S2405-4569(21)00321-7.