Nocturnal Urination (Nocturia): Or something else? Differential Diagnosis

Blood, blood-forming organs-immune system (D50-D90).

  • Anemia (anemia)
  • Sickle cell anemia (med.: drepanocytosis; also sickle cell anemia, sickle cell anemia) – genetic disease of erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin called sickle cell hemoglobin, HbS).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Obesity (obesity)
  • Conn syndrome (primary hyperaldosteronism)
  • Cushing’s disease
  • Diabetes insipidus – hormone deficiency-related disorder in hydrogen metabolism, which leads to extremely high urine excretion (polyuria; 5-25 l/day) due to a limited ability of the kidneys to concentrate; associated with this is an increased feeling of thirst (polydipsia; drinking 3.5 l/24 hours).
  • Diabetes mellitus (diabetes) – clinical symptoms: glucosuria (excretion of glucose in the urine), polydipsia (> 4 l/day; increased thirst).
  • DIDMOAD syndrome (synonym: Wolfram syndrome) – genetic disease with autosomal recessive inheritance; symptom complex with diabetes mellitus, diabetes insipidus (hormone deficiency-related disorder in hydrogen metabolism, which leads to extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentration capacity of the kidneys), optic atrophy (tissue atrophy (atrophy) of the optic nerve / optic nerve), sensorineural hearing loss.
  • Fanconi syndrome (synonyms: Gluco-amino-phosphate diabetes, De-Toni-Debré-Fanconi syndrome, Reno-tubular syndrome (Fanconi).
    • Genetic (hereditary De-Toni-Debré-Fanconi syndrome; autosomal recessive inheritance) – renal dysfunction (proximal tubule) with urinary excretion of glucose, amino acids, potassium, phosphate, and protein; hypercalcemia with risk of nephrocalcinosis and metabolic acidosis (metabolic acidosis)
    • Acquired as a result of secondary genesis (e.g. metabolic diseases; nephrotoxic substances).
  • Hypercalcemia (calcium excess).
  • Hyperglycemia (hyperglycemia)
  • Hyperthyroidism (hyperthyroidism)
  • Hypokalemia (potassium deficiency)
  • Malnutrition (malnutrition)
  • Graves’ disease – form of hyperthyroidism (hyperthyroidism) caused by an autoimmune disease. It is a hyperthyroidism induced by stimulating autoantibodies against the TSH receptor (TRAK).
  • Cushing’s disease – group of diseases leading to hypercortisolism (hypercortisolism).

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99)

  • Heart failure (cardiac insufficiency) – clinical symptoms: peripheral edema (water retention) in dependent parts of the body (ankles, lower legs, sacral in bedridden patients), nocturia, dyspnea (shortness of breath or shortness of breath; at rest or on exertion).
  • Hypertension (high blood pressure)
  • Mitral stenosis (mitral valve stenosis)
  • Supraventricular tachycardia – tachycardia in which there are up to heart rates of 150-220 beats/minute; the origin of the excitation in the area of the atrium (atrium cordis) at the sinoatrial node, atrioventricular node, or His bundle.
  • Thrombosis (vascular disease in which a blood clot (thrombus) forms in a vessel) of the inferior vena cava (inferior vena cava)
  • Venous congestion

Infectious and parasitic diseases (A00-B99).

  • Filariasis – infestation by threadworms.
  • Hookworm infestation
  • Renal tuberculosis

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Liver cirrhosis – irreversible damage to the liver and marked remodeling of liver tissue.

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Neoplasms – tumor diseases (C00-D48).

  • Urinary bladder tumor, unspecified.
  • Neoplasm in the pelvis, unspecified
  • Prostate carcinoma (prostate cancer)

Psyche – nervous system (F00-F99; G00-G99)

  • Multiple sclerosis (MS)
  • Psychogenic polydipsia – compulsive water drinking.
  • Somatoform disorders (mental illness leading to physical symptoms without physical findings), unspecified

Pregnancy, childbirth and puerperium (O00-O99).

  • Pregnancy

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Dysuria – difficult (painful) urination or a weak urinary stream in bladder emptying disorders (all their causes).
  • Edema (water retention) (all their causes).
  • Pollakisuria (urge to urinate frequently without increased urination) (all their causes).
  • Polyuria (> 1.5-3 l/day); increased urination) (all their causes).
  • Cardiomegaly – enlargement of the heart beyond normal.
  • Lower urinary tract symptoms (LUTS).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Adnexitis – inflammation of the fallopian tube and ovary.
  • Benign prostatic hyperplasia (BPH; benign enlargement of the prostate gland) – clinical symptoms: weakened urinary stream, incomplete bladder emptying.
  • Chronic urinary tract infection – clinical symptomatology: pollakiuria (urge to urinate frequently without increased urination), burning during urination.
  • Chronic renal insufficiency (kidney weakness).
  • Urinary bladder neck hypertrophy
  • Urinary bladder instability
  • Urinary bladder stone
  • Interstitial cystitis (interstitial cystitis, IC; synonym: Hunner’s cystitis) – bladder inflammation of unclear etiology occurring predominantly in women with fibrosis of the bladder muscles, urge incontinence (irritable bladder or overactive (hyperactive) bladder) and development of a shrinking bladder; confirm diagnosis by: Urethrocystoscopy and biopsy for histology and molecular diagnostics of specific cell proteins.
  • Nephritis (inflammation of the kidneys), acute or chronic.
  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in urine) with protein loss of more than 1 g/m²/body surface area per day; Hypoproteinemia, peripheral edema (water retention) due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (lipid metabolism disorder).
  • Obstruction (obstruction) of the lower urinary tract.
  • Estrogen deficiency colpitis (colpitis senilis, atrophic colpitis) – clinical symptoms: increased susceptibility to urinary tract infections, pollakiuria (urge to urinate frequently without increased urination).
  • Premenstrual syndrome PMS)
  • Prostatitis (prostatitis)
  • Pyelonephritis (inflammation of the renal pelvis)
  • Overactive bladder (OAB) – clinical symptoms: pollakiuria (urge to urinate frequently without increased urination), imperative urination (urge to urinate that can not be suppressed or controlled), possibly incontinence (inability to hold urine.
  • Ureteral stone (ureteral stone).
  • Urethritis (inflammation of the urethra)
  • Cystic kidney disease
  • Cystitis (inflammation of the urinary bladder)

Medication

Further

  • Age (main risk factor!)
    • Reduced bladder capacity
    • Disruption of circadian ADH release/antidiuretic hormone (male + female);
    • Benign prostatic hyperplasia (BPH); increased residual urine volumes.
  • Alcohol
  • Excessive fluid intake in the evening!
  • Habit to go to the toilet at night
  • In winter more often than in summer due totoo low living room temperature (cold-induced detrusor overactivity); Recommendation: bedroom temperature 17 °C.
  • Space requirement in the pelvis, unspecified
  • Radiation fibrosis
  • Renal allograft (donor kidney) recipients.

Important notice.