Nocturia: Concerns for Kidney Recovery and Bladder Health

Q: Nocturia: Concerns for Kidney Recovery and Bladder Health

Hello： It is important to monitor urine output, but more importantly, one should be cautious about preventing sepsis. <br>Additionally, if you drink water during the day and are less active, much of it may turn into urine at night. <br>You might try engaging in light exercise to

Nocturia

Hello Dr.
Du, my family member (female, 29 years old) developed acute kidney failure due to sepsis and antibiotic treatment.
On 8/07, her creatinine levels were 0.48, on 11 it was 0.98, on 14 it rose to 2.78, on 17 it was 3.29, and on 22 it decreased to 0.99.
Her current estimated glomerular filtration rate (eGFR) is 68 (which may be slightly overestimated, as she has chronic conditions, has not worked and has been resting at home, and has spent over three months in the hospital this year with minimal activity, likely resulting in very low muscle mass).
She currently drinks about 2000 mL of fluids a day, consumes two fist-sized fruits, and does not eat soup.
Her daily urine output is approximately 1800-2400 mL, with about 6-7 bathroom visits during the day, each producing about 100-200 mL.
Sometimes, she may intake 1000 mL of water within three to four hours in the morning but only produces 1200 mL of urine.
By the end of the day, she produces about 1000 mL of urine (not including the morning after waking up).
Currently, she only experiences nocturia once, but it can be around 600-700 mL, and the morning output can reach 300-400 mL.
I have communicated these concerns to her nephrologist, but he did not provide much feedback.
I am worried about potential bladder damage or renal reflux affecting her kidney recovery, so I have been waking her up at night to urinate, but I am concerned about how this might impact her rest.
Is it necessary for me to wake her up for this? Additionally, I have noticed that when she lies down to rest during the day, her urine output increases, especially after a nap, but the total amount only increases by about 300 mL, with nocturia still being predominant.
Should I consider consulting a urologist? My main concern is whether it is necessary to wake her up at night to urinate, as she experienced about 400 mL of nocturia during one hospital stay, waking up 2-3 times a night, and last month it changed to once with 500-600 mL, and this month it has increased to 600-700 mL, giving the impression that her bladder is getting larger.

Li, 30~39 year old female. Ask Date: 2017/09/28

Dr. Du Shixi reply Urology

Hello: It is important to monitor urine output, but more importantly, one should be cautious about preventing sepsis.
Additionally, if you drink water during the day and are less active, much of it may turn into urine at night.
You might try engaging in light exercise to see if it changes the distribution of your urine output.
As for whether there is any renal reflux affecting the kidneys (which is generally not the case for most people), a urology specialist would need to conduct an examination to determine that.
It's best to avoid beverages and stick to plain water for hydration.

Reply Date: 2017/09/28

More Info

Nocturia, or the need to wake up at night to urinate, can be a concerning symptom, especially in the context of kidney recovery and bladder health. In your family member's case, the history of acute kidney injury (AKI) following sepsis and the subsequent fluctuations in creatinine levels indicate that her kidneys are still in a recovery phase. The fact that she is producing a significant amount of urine during the night, along with the volume of fluid intake, raises several important considerations.

Firstly, it is essential to understand that the kidneys play a crucial role in regulating fluid balance and waste elimination. After an episode of acute kidney injury, the kidneys may take time to regain their full function. The fluctuating creatinine levels you mentioned suggest that her renal function is still being assessed and may not yet be stable. The estimated glomerular filtration rate (eGFR) of 68 indicates mild to moderate impairment, which can affect her overall fluid handling and urine output.

The nocturia experienced by your family member, particularly the increased volume of urine produced at night, could be attributed to several factors. One possibility is that her kidneys are compensating for the reduced function by concentrating urine during the night when she is less active. This can lead to a higher volume of urine being produced during the night, which may explain the 600-700cc output you noted. Additionally, the fact that she is consuming around 2000cc of fluids daily, along with fruits, may also contribute to her urine output.

Regarding your concern about bladder health and the potential for kidney reflux, it is important to note that the bladder is designed to accommodate varying volumes of urine. However, if the bladder becomes overly distended or if there is a significant increase in pressure, there is a risk of urine refluxing back into the kidneys, which can lead to further complications. Encouraging her to void regularly during the day and minimizing the need for nighttime urination can help reduce this risk.

You mentioned that you have been waking her up at night to urinate, which can be a double-edged sword. While it may help prevent bladder overdistension and potential reflux, it can also disrupt her sleep, which is crucial for recovery. If she is able to manage her fluid intake during the day and void adequately, it may be beneficial to allow her to sleep through the night without interruption, unless she expresses discomfort or urgency.

In terms of seeking further evaluation, it may be worthwhile to consult a urologist, especially if you notice any changes in her urinary patterns, such as increased frequency, urgency, or discomfort. A urologist can assess her bladder function and determine if there are any underlying issues that need to be addressed. Additionally, they can provide guidance on managing nocturia and ensuring that her bladder health is maintained during her recovery.

In summary, while nocturia can be concerning, it is essential to balance the need for regular voiding with the importance of rest and recovery. Monitoring her urinary patterns, maintaining adequate hydration during the day, and consulting with a urologist if necessary can help ensure that her kidney and bladder health are appropriately managed during this recovery phase.

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