Glycosuria

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Glycosuria

ICD-10 R81.

ICD-9 791.5

DiseasesDB 5323

MeSH D006029

Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine
contains no glucose because the kidneys are able to reclaim all of the filtered glucose
back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose
levels, most commonly due to untreated diabetes mellitus. Rarely, glycosuria is due to an
intrinsic problem with glucose reabsorption within the kidneys themselves, a condition
termed renal glycosuria.[1] Glycosuria leads to excessive water loss into the urine with
resultant dehydration, a process called osmotic diuresis.

[edit] Pathophysiology
Blood is filtered by millions of nephrons, the functional units that comprise the kidneys.
In each nephron, blood flows from the arteriole into the glomerulus, a tuft of leaky
capillaries. Bowman's capsule surrounds each glomerulus, and collects the filtrate that the
glomerulus forms. The filtrate contains waste products (e.g. urea), electrolytes (e.g.
sodium, potassium, chloride), amino acids, and glucose. The filtrate passes into the renal
tubules of the kidney. In the first part of the renal tubule, the proximal tubule, glucose is
reabsorbed from the filtrate, across the tubular epithelium and into the bloodstream. The
proximal tubule can only reabsorb a limited amount of glucose. When the blood glucose
level exceeds about 160 - 180 mg/dl (8.9 - 10 mmol/l), the proximal tubule becomes
overwhelmed and begins to excrete glucose in the urine. [2]

This point is called the renal threshold of glucose (RTG) [3]. Some people, especially
children and pregnant women, may have a low RTG (less than ~7 mmol/L[3] glucose in
blood to have glucosuria).

If the RTG is so low that even normal blood glucose levels produce the condition, it is
referred to as renal glycosuria.
Glucose in urine can be identified by Benedict's qualitative test.

Clinical diagnosis of the diabetes require some of the laboratory tests, glycosuria (finding glucose
in the urine) is one of the significant test for detecting frank diabetes. Those who are non
diabetic, for them glycosuria can occur for the short term due to emotional stress, pain,
hyperthyroidism, alimentary hyperglycemia or meningitis. It can also occur when there is
insufficiency of insulin and if a substantial amount of food with high sugar is consumed.

Glycosuria is a condition in which glucose or simple sugar is detected in the urine despite of
normal blood sugar level. The normally functioning kidneys absorb and reabsorb the extra blood
sugar till renal threshold, with the help of millions of micro tubules – Nephron (filtering unit of
kidney). The renal threshold is a concentration level above which all simple sugar is not absorbed
in the blood; hence extra glucose is excreted by the kidneys in the urine. Renal threshold of
normal kidney is around 10mmol/L. In few cases, when drugs are used for a longer span of time,
it may alter the threshold level of kidney. The amount of glucose not reabsorbed by the kidneys
is usually less than 0.1%. Adults excrete about 65 mg of glucose per day. The relationship
between glycosuria and the renal threshold are explained in the diagram given below.

In renal glycosuria glucose is abnormally eliminated in the urine due to improper action of the
nephron.

The renal glycosuria occurs only when there are abnormally functioning kidneys, due some dent
in the kidneys or as an autosomal recessive trait.

The suspected causes of renal glycosuria can be that the level of blood glucose could get too
high due to which the renal tubules cannot reabsorb it completely or, there might be failure of the
tubules to reabsorb all the glucose. Thyrotoxicosis, Acromegaly, Cushing's syndrome, Rapid
gastric emptying (dumping syndrome) and peptic ulcers, all these can raise blood glucose above
the threshold. Stress hormones elevate blood glucose and in a severely ill patient they may even
elevate glucose, beyond the renal threshold.

Secondary causes elevating urine sugar level (temporarily) are as stated below-

• Pregnancy: During pregnancy there is increased renal blood flow, leading to lowered
renal threshold
• Oculocerebrorenal Dystrophy (Lowe syndrome)
• Cystinosis
• Wilson's disease
• Interstitial nephrities
• Hereditary tyrosinaemia
• Heavy metal poisoning such as lead, mercury or with old tetracycline
• Intestinal glucose-galactose malabsorption

Glycosuria occurs without significant pathology and is mainly bifurcated into 3 categories:-

• Type A :- it is classical glycosuria, with decline in both, glucose threshold and maximal
glucose reabsorption rate.
• Type B :- There is a decline in the glucose threshold and a normal rate of reabsorption.
• Type O :-There is failure of glucose reabsorption. Plasma glucose, glucose tolerance
test, insulin levels and HbA1C, all are normal.
Mainly for the affected individuals, this condition causes no visible signs and symptoms or serious
effects, but it is a marker for detecting the status of kidney and a diabetic.

Synonyms of glycosuria are listed below

• Benign glycosuria
• Familial renal glycosuria
• Nondiabetic glycosuria
• Primary renal glycosuria
• Diabetes renalis
• Renal diabetes