2. POLYUREA
BASICS

3. Polyuria defined as urine out put is >3ml/kg/h
BASICS
Polyuria defined as urine out put is >3ml/kg/h

4. Acquired dysfunction of salt & water reabsorption
Causes
Acquired dysfunction of salt & water reabsorption
Obstructive uropathy
Osmotic diuresis
ATN (diuretic phase)
Tubulointerstial damage (CKD)
Drugs
diuretics
Corticosteroids
caffiene
Serious systemic infection
Hypercalciemia (↑13mg/dl )
hypokalemia

5. Herediatry tubulopathies affecting salt reabsorption
Causes
Herediatry tubulopathies affecting salt reabsorption
RTA
Proximal (fanconi syndrome)
Distal (interstial nephritis)
Hyperkalemic, aldosterone defect (obstructive uropathy)
Bartter syndrome (AR)
ADH abnormalities
Centeral DI
Nephrogenic DI

6. Renal tubular acidosis (the essentials )
Failure to thrive
Chronic vomiting
Episodes of metabolic acidosis
Hypercholremic metabolic acidosis with NAG
Usually normal renal function
It is 4 types (proximal , distal , hyperkalemic & mixed)

7. Barrter (the essentials )
Failure to thrive
Chronic vomiting
metabolic alkalosis
Hypocholremia
Hypokalemia
Elevated plasma renin and aldosterone

8. Diabetes insipidus Sever polyuria Hypernatremia
Serum osmolarity >280
Urine osmolarity <280
Response to desmopressin (central type)

9. ASK FOR
Stress to confirm polyurea (Recurrent dehydration with no significant vomiting)
CKD
Diuretics or corticosteroids
Dark urine
Is the paient diabetic
Head trauma

10. Examine for Urine volume Hydration state Acidotic breathing
Weight centile
Blood pressure
Racketic manifestations Evidence of CKD
Renal mass
Cushinoid features

11. Step 1: confirm polyurea
Step 2: review your history and examination
Exclude AQUIRED CAUSES at least
Step3: initial investigations
Urine analysis (SG , glycosuria )
Blood sugar level
Serum urea & creatnine
Serum electrolytes (calcium , potassium & sodium)
ABG
Abdominal US
Step 4: Classify according ABG
No acidosis or alkalosis
Metabolic acidosis
Metabolic alkalosis

12. Polyuria with metabolic acidosis
Calculate anion gap
Normal
Wide
Consider RTA
Serum K
Role out
renal failure
Dehydration
Elevated
Normal or low
Urine PH
Consider type IV
Investigate for aldosterone defect and obstructive uropathy & drugs
<5.5
Consider PRTA
Investigate for fanconi syndrome
>5.5Consider DRTA
Investigate for INTERSTIAL NEPHRITIS

13. Polyuria with metabolic Alkalosis
Role out loop diuretics and chronic vomiting
Consider barrter syndrome
Confirm
Serum potassium (low)
Serum renin and aldosterone (low)

14. Polyuria with no metabolic acidosis or alkalosis
Role out acquired causes espically
Hypercalcemia
Hypokalemia
Drugs
Do serum & urine osmolarity
Plasma osmalrity >280 Or
Urine osmalrity <280 NO
YES
Water deprivation test
Diagnostic for DI (no need for WDT