Nocturnal Polyuria in Older People: Pathophysiology and Clinical Implications

Abstract

As a consequence of age-associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin-angiotensin-aldosterone, and increased secretion of atrial natriuretic hormone, there is an age-related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age-related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.

Downregulation of renal vasopressin V2 receptor and aquaporin-2 expression parallels age-associated defects in urine concentration

“…Moderate water restriction induced equivalent relative increases in renal AQP2 abundances in all age groups but resulted in significantly lower abundances in total kidney AQP2 protein in aged compared with young F344BN rats. These results therefore demonstrate a functional impairment of renal concentrating ability in aged F344BN rats that is not due to impaired secretion of AVP but rather appears to be related to impaired responsiveness of the kidney to AVP that is secondary, at least in part, to a downregulation of renal V2R expression and AQP2 abundance.aging; aquaporins; kidney AN AGE-RELATED DECLINE IN urinary concentrating ability has been documented in experimental animals as well as in elderly humans (2,3,13,16,17,20,30,31). Both the increase in urinary concentration and the decrease in urine volume that are characteristically observed after water deprivation are reduced in aged compared with young humans.…”

“…aging; aquaporins; kidney AN AGE-RELATED DECLINE IN urinary concentrating ability has been documented in experimental animals as well as in elderly humans (2,3,13,16,17,20,30,31). Both the increase in urinary concentration and the decrease in urine volume that are characteristically observed after water deprivation are reduced in aged compared with young humans.…”

Effects of desmopressin for the treatment of nocturnal polyuria in elderly women: impact on related sleep quality

“…A significant proportion of elderly patients with nocturia lack this physiologic increase of the ADH during nighttime. 2,7 Advancing age is associated with a decrease of nighttime excretion of ADH, so that the ADH level during daytime and nighttime becomes similar. 7 In the present study, we included elderly women over 60 with persistent nocturnal polyuria and treated them conservatively (including behavioral modification, fluid restriction, anticholinergic treatment, and diuretics) for their nocturia.…”

Oral Desmopressin in the Management of Adults with Nocturia

“…Nocturia may be due to either polyuria, nocturnal polyuria or low bladder capacity [6]. As the diurnal variation in AVP release is absent in many older subjects [7], nocturnal polyuria, or the over-production of urine at night, is an important cause of nocturia [8], that may be due to age-related changes in the secretion and action of arginine vasopressin (AVP) [9,10]. Treatments currently licensed to improve bladder function do not control nocturnal polyuria [11].…”