Opsouria is a pathological condition in which copious urine output is observed not in the near future after drinking a large amount of liquid, but after 24 or more hours. It is found in heart failure, portal hypertension, hyperglycemia, hypernatremia, and some endocrine diseases. The cause of opsouria is established on the basis of complaints, anamnesis data, results of a physical examination and additional diagnostic procedures. As part of the treatment, hormones, beta-blockers, nitrates, vasodilators and other drugs are prescribed. According to indications, surgical interventions are carried out.
Why does opsouria occur?
Heart failure
Pathology is associated with a decrease in the pumping function of the myocardium, is a complication of a number of cardiac diseases. Fluid retention in the body and its subsequent delayed excretion through the kidneys are due to circulatory disorders. Heart failure, accompanied by the development of opsouria, can be observed with the following pathologies:
- Ischemic heart disease: severe angina pectoris, myocardial infarction, postinfarction cardiosclerosis.
- Rheumatic heart disease: mitral and aortic insufficiency, mitral and aortic stenosis, tricuspid insufficiency, combined and combined defects.
- Other causes: dilated cardiomyopathy, hypertension, symptomatic hypertension.
Patients with opsouria are also concerned about shortness of breath, edema, tachycardia, fatigue, exercise intolerance. There are violations of the work of the kidneys, respiratory system and gastrointestinal tract. In the later stages, ascites, hydropericardium, hydrothorax occur.
portal hypertension
Polyetiological condition with increased pressure in the portal vein system and concomitant disorders of venous blood flow. Opsouria is formed in the late stages of portal hypertension, combined with edema of the lower extremities against the background of protein homeostasis disorders. It can be detected in the following diseases:
- Cirrhosis: alcoholic, primary and secondary biliary.
- Acute and chronic hepatitis: alcoholic, viral (more often - hepatitis B and C), autoimmune, medicinal, specific (for example, against the background of echinococcosis).
- Liver neoplasia: hepatocellular carcinoma, cholangiocarcinoma, angiosarcoma, hepatoblastoma, less often large benign neoplasms.
- Biliary tract involvement: gallstone disease, ligation, or accidental damage to the ducts during surgery.
- Tumors of the pancreas: cancer of the head of the pancreas.
- Vascular pathologies: thrombosis, developmental anomalies, Budd-Chiari syndrome.
Along with opsouria, dyspepsia, jaundice, splenomegaly, weakness, and fatigue are observed. Characterized by persistent ascites in combination with edema of the distal lower extremities. There are gastric and hemorrhoidal bleeding. A network of dilated saphenous veins is revealed on the anterior surface of the abdomen.
Opsouria
Increase in osmotic pressure
Opsouria on the background of hyperglycemia, as a rule, develops in patients with diabetes mellitus. Less commonly, the cause of this condition is hypercortisolism with Itsenko-Cushing's disease or syndrome, acromegaly against the background of somatotropinoma, some other endocrine pathologies, severe diseases of the central nervous system and internal organs, and taking medications. The condition is accompanied by dry mouth, muscle weakness.
With hypernatremia, opsouria is provoked by excessive intake or reduced excretion of sodium, lack of fluid, and medication. The disturbance may occur due to increased sweating, repeated vomiting, excessive administration of hypertonic saline, use of dialysis fluids with a high sodium content. Etiological factors also include hyperaldosteronism, Conn's syndrome, kidney and liver disease, overdose of diuretics and ADH blockers.
Other endocrine pathologies
Opsouria can occur with hypothyroidism. It is especially pronounced in myxedema. It is combined with swelling of the skin and subcutaneous tissue, a mask-like puffy face, lethargy, chilliness, muscle weakness, slowing down of movements and cognitive processes. Hydropexic syndrome is formed due to an increase in the level of ADH in violation of the pituitary gland and hypothalamus, the release of vasopressin by tumors of other localizations. Opsouria against the background of hydropectic syndrome sometimes accompanies the following diseases:
- Damage to the hypothalamus: with head injury, hemorrhage, encephalitis, meningitis.
- Hormone-producing neoplasias: bronchogenic cancer, thymoma, lymphosarcoma, pancreatic neoplasms.
- Mental disorders: depression, chronic stress, psychotrauma, psychosis.
- Long-term medication: tranquilizers, neuroleptics.
Diagnostics
Due to the polyetiology of opsouria, the examination is carried out by specialists of various profiles. Primary diagnosis in case of planned treatment is carried out by a general practitioner, in the event of emergency conditions - an emergency doctor. Depending on the identified violations, patients are referred to a cardiologist, gastroenterologist, endocrinologist, etc.
To establish the fact of opsouria, the moment of taking a large volume of liquid and the time interval before the appearance of profuse urination are clarified. During the survey, other manifestations of the disease are detected, the dynamics of its development is assessed. During the physical examination, edema, jaundice, ascites and other external signs indicating the nature of the pathology are detected. As part of an additional examination, procedures such as:
- Electrophysiological methods. In patients with suspected heart failure, an ECG is performed to detect arrhythmias, ischemia, and myocardial hypertrophy. Additionally, exercise tests (treadmill test, bicycle ergometry) are carried out to study the reserve capacity of the heart muscle.
- Ultrasonography. Sonography helps to evaluate the pumping function of the heart, to determine the cause of heart failure. With portal hypertension, ultrasound of the abdominal cavity is performed, as well as ultrasound of the liver and biliary tract, dopplerometry of the liver vessels. With myxedema, ultrasound of the thyroid gland is performed.
- Beam techniques. Patients with heart failure are prescribed chest x-ray to detect cardiomegaly and congestion in the lungs. Portography, cavagraphy, celiacography, splenoportography, angiography of mesenteric vessels are performed for patients with portal hypertension. If damage to the hypothalamus and pituitary gland is suspected, CT or MRI is performed.
- Laboratory tests. With signs of heart failure, acid-base balance, gas and electrolyte composition of the blood, cardiospecific enzymes, creatinine, and urea are determined. In the presence of portal hypertension, KLA, OAM, blood biochemistry, a coagulogram, tests for serum immunoglobulins and antibodies to hepatitis viruses are prescribed. In case of hyperglycemia, indicators of carbohydrate metabolism are examined. With endocrine pathologies, tests for hormones are carried out.
Urinalysis
Treatment
Conservative therapy
Depending on the causes of opsouria, the following conservative methods are used:
- Heart diseases. A diet with salt and fluid restriction, cardiac glycosides, ACE inhibitors, vasodilators, nitrates, diuretics, beta-blockers, anticoagulants, potassium preparations, ascorbic acid, B vitamins are shown.
- portal hypertension. Conservative treatment is effective only at the initial stage, is carried out using nitrates, glycosaminoglycans, ACE inhibitors, beta-blockers. Subsequent surgical interventions are required.
- Hyperglycemia. Patients are prescribed a special diet, hypoglycemic agents, insulin preparations. Regular physical activity is recommended to lower glucose levels. With a drug-induced form, the provoking drug must be discontinued.
- Hypernatremia. Therapy is carried out under the control of the amount of fluid administered and the level of electrolytes. Taking into account the cause of the violation, oral or intravenous hydration, loop diuretics, synthetic analogues of antidiuretic hormone are prescribed.
- Myxedema. Advise a diet with restriction of salt and fats. With iodine deficiency, foods rich in iodine are added to the diet. Thyroid hormone preparations, glucocorticosteroids are used. If necessary, diuretics and antiarrhythmic drugs, cardiotonic drugs, nootropics are used.
- hydropectic syndrome. A low-calorie salt-free diet with a decrease in the amount of liquid, fats and carbohydrates is required. Drug therapy includes potassium-sparing diuretics, ADH antagonists, magnesium and potassium preparations. Neoplasms are treated with chemotherapy and radiation therapy.
Surgery
Taking into account the cause of opsouria, the following operations are carried out:
- Cardiac pathologies: balloon valvuloplasty, closed or open commissurotomy with mitral stenosis; shortening plastic of chords, annuloplasty, prosthetics or valve plastic for mitral insufficiency; endovascular balloon dilatation, valvuloplasty, or aortic valve replacement for aortic malformations.
- Portal hypertension: selective splenorenal, mesenteric-caval or porto-caval shunting, splenectomy, reduction of splenic blood flow; sclerosis or ligation for bleeding from the veins of the stomach and esophagus; laparocentesis or drainage of the abdominal cavity as part of palliative care.
- Hyperglycemia: gastric banding or gastric bypass in the presence of morbid obesity; bilateral removal of the adrenal glands in Cushing's syndrome; transnasal adenomectomy for pituitary tumors.
- Hydropexic syndrome: pancreatoduodenal resection, stenting of the common bile duct, endoscopic bougienage of strictures, external drainage of the bile ducts in case of pancreatic neoplasia; thymectomy or thymothymectomy for thymomas; lobectomy, bilobectomy, pneumonectomy for bronchial cancer.