Abstract
Nocturnal polyuria (NP) is an important cause of nocturia and it is related to an imbalance in water and/or sodium homeostasis. Antidiuretic hormone (ADH) and atrial natriuretic peptide (ANP) are believed to play an important role in this excessive urine production overnight, however, many other hormones are involved. ADH and ANP are both directly and indirectly influenced by the renin-angiotensin-aldosterone system (RAAS), prostaglandins antagonize both ADH and RAAS and sex hormones have a predominantly antidiuretic effect by stimulating ADH and RAAS, meaning that any disturbance can lead to an imbalance in diuresis. Since nocturia is a condition affecting sleep, melatonin secretion can also be affected, leading to a decrease in the antidiuretic effect and to an increase of nocturnal urine production. Depending on the underlying condition affecting any of these hormones, a more specific therapeutic approach might lead to a restoration of the normal diuresis cycle and to a good night’s sleep. The characteristics of each of these hormones, the pathophysiology in NP and the therapeutic implications are set out in this review.
Highlights
Nocturia is the need to get up once or more to void at night
Nocturnal polyuria (NP) is an important cause of nocturia and it is related to an imbalance in water and/or sodium homeostasis
Antidiuretic hormone (ADH) and atrial natriuretic peptide (ANP) are both directly and indirectly influenced by the renin-angiotensin-aldosterone system (RAAS), prostaglandins antagonize both ADH and RAAS and sex hormones have a predominantly antidiuretic effect by stimulating ADH and RAAS, meaning that any disturbance can lead to an imbalance in diuresis
Summary
Nocturia is the need to get up once or more to void at night. The underlying problem can be reduced bladder capacity, diurnal polyuria and nocturnal polyuria; each of these can be caused by several conditions. In this review we would focus on the problem of nocturnal polyuria [1]. To fully understand this topic, a basic knowledge of water and sodium homeostasis is necessary. Nocturnal polyuria due to disturbances in water handling is usually caused by an impairment of the antidiuretic hormone. If a disturbance in sodium handling seems to be the problem, natriuretic peptides are often involved [2,3]. Both of these hormones affect and are affected by the renin-angiotensinaldosterone system [4]. There is evidence that other hormones, such as melatonin and sex hormones affect these pathways one way or another [5,6]. this article highlights the physiological mechanisms of each of these hormones and discusses how this fits in the pathophysiology of nocturnal polyuria, providing evidence for pharmacotherapeutic options
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