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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 172-175

Frequency of urination as a presenting symptom in COVID-19 patients: A preliminary study from multiple centres


Department of General Surgery and Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Submission23-Aug-2020
Date of Acceptance06-Jul-2021
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Hashim Talib Hashim
Iraq – Dhi Qar – Nassiryah – 400 Street
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_13_20

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  Abstract 


Background: COVID-19 has become a big challenge for the humanity and the public health; it is progressing in all the world and the number of cases exceeded the millions with a high rate of mortality. The disease is presented with a variety of symptoms and in different extents but predominantly with respiratory symptoms such as fever and shortness of breath.
Methodology: It is a preliminary, descriptive cross-sectional study that includes 503 patients from four counties and more than ten isolation centres. It includes all the patients who were presented with frequency of urination in addition to the other disease's symptoms. The frequency of urination was identified by micturition frequency for more than 10 times a day with exclusion of the hormonal diseases related to the micturition.
Results: 96.23% of the patients were presenting with fever and 89.28% of them with dry cough, only 39.68% of them were with mild to no symptoms. 59.72% of them urinated for 10–13 times per 24 h and 49.6% of them have the symptom for 3-day duration. 82.43% of the patients have a small amount of urine (<300 cc) for each micturition. Some of them were recognised to have diabetes mellitus, hypertension and urinary tract infections.
Conclusion: Frequent urination can be considered a new symptom for COVID-19 with some criteria of presentation The duration of the symptom ranging from 3 days to 10 days, and it depends on the case and the patient's age and gender in addition to the severity of the disease.

Keywords: Chronic disease, COVID-19, frequency of urination, micturition, presenting symptoms


How to cite this article:
Hashim HT. Frequency of urination as a presenting symptom in COVID-19 patients: A preliminary study from multiple centres. Curr Med Res Pract 2021;11:172-5

How to cite this URL:
Hashim HT. Frequency of urination as a presenting symptom in COVID-19 patients: A preliminary study from multiple centres. Curr Med Res Pract [serial online] 2021 [cited 2021 Sep 25];11:172-5. Available from: http://www.cmrpjournal.org/text.asp?2021/11/4/172/324248




  Introduction Top


COVID-19 has become a big challenge for the humanity and the public health, it is progressing in all the world and the number of cases exceeded the millions with a high rate of mortality.[1]

It can cause death not only amongst the elders and immunosuppressed patients but also it has been reporting to cause death amongst children and youths even if there immune system is competent.[2]

The pathogenesis of the virus has not well understood yet, it does not affect the lungs only, it is recognised to cause hyper-coagulation in the blood vessels, especially the pulmonary venous system as shown in autopsies.[3],[4]

The most presenting symptoms for the disease are fever, dyspnoea, dry cough and headache with a variety of percentages and in addition to other uncommon symptoms such as diarrhoea and loss of taste and smell.[5],[6],[7]

Fever is the cardinal feature of the disease that can be used as an indicator for the suspicion.

Other symptoms related to neurology and gastrointestinal are reported too in many cases around the world.[5]

While older people and those immunosuppressed may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium and absence of fever.[8]

It is believed that COVID-19 is similar to SARS-COV by binding to angiotensin-converting enzyme receptor 2 (ACE 2) through SB to enter the target cells.[9],[10]

This attachment may have a role in originating effects of the renal system, and the virus may have a pathogenesis in the renal system as well as the other organs.[10]

In this study, I am reporting on the frequency of urination as a presenting symptom in the patients with confirmed cases of COVID-19 that can be used as an early indicator for the disease.


  Methodology and Patients Top


It is a preliminary, descriptive cross-sectional study that includes 503 patients from 4 countries (Iraq, Iran, Saudi Arabia and Turkey) and 12 centres of COVID-19 patients isolation in these countries, the data were obtained from these 12 hospitals as preserved data.

It includes all the patients who were presented with frequency of urination (after being diagnosed with COVID-19) in addition to the other disease's symptoms with mentoring the amount of fluid intake per day.

The frequency of urination was identified by micturition frequency for more than 10 times within 24 h with exclusion of the hormonal diseases related to the micturition.

The amount of urination and volume was assessed by asking the patients to collect it in as assessment cup in millilitres (not all centres did this and the majority of them assessed it theoretically by small [<300 cc], moderate [300–400 cc] and large amount [>400 cc]).

All the patients' data were recorded, and full medical history was taken from each patient himself individually by the treating doctor. Medical examination, laboratory tests and urinalysis (including cultures) were done to exclude other diseases and to identify chronic diseases.

The data were collected and obtained officially from the 12 centres and analysed using Statistical Package for the Social Sciences program version 25 (IBM, Norman H. Nie, C. Hadlai (Tex) Hull and Dale H. Bent, USA).

All the patients gave their verbal consents to share their data and medical history for research purposes.

The ethical approval was obtained from the ethical committee in the university of Baghdad, College of Medicine and under the supervision of the Iraqi ministry of health.


  Results Top


The ages of the patients ranged 5 years–76 years old with a mean of 34.5 (30.55% of them under the age of 12 years old).

Nearly 74.2% of them were males (374 patients) and 25.68% of them were females (130 patients).

One hundred and thirty-four patients from Iraq (26.58%), 214 patients from Iran (42.46%), 111 patients from Turkey (22.02%) and 45 patents from Saudi Arabia (8.92%).

[Table 1] presents the symptoms that the patients complained on diagnosis with their duration and percentages.
Table 1: The presenting symptoms of the patients on admission

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About 59.52% of our patients were presenting with no radiological signs for pneumonia (300 patients) and 40.48% of them (204 patients) were presenting with radiological sings for pneumonia [clarified in [Figure 1]] which was a variety of ground-glass appearances.
Figure 1: Four different X-rays for the patients

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All of the patients were presented with frequency of urination and [Table 2] clarifies the details of the presentation of this symptom.
Table 2: The details of the frequency of urination among the patients

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[Figure 2] clarifies the chronic diseases and other diseases that the patients have either already known or diagnosed later after the admission.
Figure 2: The diseases that the patients have other than COVID-19

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There is a significant difference between the age of the patients and the duration of the frequency of urination with P value of 0.01 and there is also a significant difference between the gender of the patients and the number of micturition per 24 h with P value of 0.002 with confidence interval of 95%.

All the patients were on a supportive treatment for the symptoms with antibiotics differs with the country and the centres which were not included in the data of the patients.

The outcomes of the patients and the follow-up were done under the supervision of the specialist in each centres.


  Discussion Top


The data findings showed that the frequency of urination is presenting symptoms with COVID-19 patients, which was exacerbated by the disease after getting infection.

There are many causes for the frequency of urination (taking in consideration the exclusion of the hormonal diseases, diabetes mellitus (DM) and the over intake of fluid), one of these causes is the renal disease (bladder infection which more common in children and females, urinary incontinence, interstitial nephritis, kidney failure and kidney stones).[11],[12],[13]

The higher urinary frequency is unclear, and there is not an explanation for this symptom and its linkage with the patients with COVID-19, because the patients have not signs of renal diseases, benign prostatic hyperplasia or any other diseases that could cause the frequency of urination and even the low percentage of those who have the renal disease were in different situation before got infected with the virus. A study suggested that SARS-CoV-2 may cause viral cystitis which in turn causes the urinary frequency symptom. It is unclear whether replication of SARS-CoV-2 RNA in urothelial cells or secondary effects due to local or systemic inflammation, such as endotheliitis, are a hallmark in COVID-19 patients, leading to symptoms such as irritative symptoms of the lower urinary tract and high urinary frequency according to their insights.[14]

In my opinion, the attachment of the virus to the angiotensin receptors will prevent the aldosterone and/or antidiuretic hormone from controlling the urination, so the patient will develop a frequent urination because the virus is similar to SARS-COV by binding to ACE 2 througha SB to enter the target cells.[9],[10]

Another explanation may be useful for the case: psychogenic polydipsia is characterised by excessive fluid intake in the absence of physiological stimuli to drink. Psychogenic polydipsia which is caused by psychiatric disorders, often schizophrenia, is often accompanied by the sensation of dry mouth and desire to drink which is then stimulate the micturition process, this does not well explain our results because the water intake was monitored for the patients, but the pandemic and its fears and psychological impacts may increase the anxiety, depression and stress level with the patients (it is recognised to increase them in normal people, so how about who are already infected?).[15],[16],[17],[18]

As the majority of our samples were children and a good percentage of them were females, and as we found a significant difference between the age and the gender with the duration and the times of the frequent urination, this may suggest the last explanation as a possible one for the emerging of the symptom in such patients.


  Conclusion Top


Frequent urination can be considered a new symptom for COVID-19 with some criteria of presentation.

It is more commonly accounted amongst children and females in addition to those with chronic diseases such as DM and hormonal diseases.

The duration of the symptom ranging from 3 days to 10 days, and it depends on the case and the patient's age and gender in addition to the severity of the disease.

There are many explanations for the emerging of this symptom, but as we all know, the pathogenesis of the virus is still non-understood and every day there are another manifestations grow up associated with the disease, so we should not be surprised of anything mysterious and unusual.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.  Back to cited text no. 1
    
2.
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 2020;55:2000547.  Back to cited text no. 2
    
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Lisa M B, Eric JD, Edana S, Subha G, Sanjay M. Covid-19 autopsies, Oklahoma, USA. Am J Clin Pathol 2020;153:725-33.  Back to cited text no. 3
    
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Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020;73:239-42.  Back to cited text no. 4
    
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Lei P, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115:766-73.  Back to cited text no. 5
    
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Lauer SA, Grantz KH, Bi F, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: Estimation and application. Ann Intern Med 2020;172:577-82.  Back to cited text no. 6
    
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Carol HY, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020;10:806-13.  Back to cited text no. 7
    
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Jinyang G, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology 2020;158:1518-9.  Back to cited text no. 8
    
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Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function and antigenicity of the SARS-CoV-2 spike glycoprotein. BioRxiv 2020;181:281-92.e6.  Back to cited text no. 9
    
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Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74.  Back to cited text no. 10
    
11.
Mills K, West E, Grundy L, Sellers DJ, Rose'Meyer R, McDermott C, et al. Bladder inflammation induced by cyclophosphamide causes increased frequency of voiding associated with hypersensitivity of sensory nerves. Aust N Z Continence J 2018;24:245-61.  Back to cited text no. 11
    
12.
Sarfaraz K. Frequency of urinary incontinence among female athletes of Karachi. Ann Jinnah Sindh Med Univ 2018;4:80-5.  Back to cited text no. 12
    
13.
Nishijima S, Sugaya K, Kadekawa K, Ashitomi K, Ueda T, Yamamoto H. Mechanisms underlying the effects of propiverine on bladder activity in rats with pelvic venous congestion and urinary frequency. Biomed Res 2019;40:145-52.  Back to cited text no. 13
    
14.
Jan-Niclas M, Osterman A, Ruzicka M, Stihl C, Vilsmaier T, Munker D, et al. Urinary frequency as a possibly overlooked symptom in COVID-19 patients: Does SARS-CoV-2 cause viral cystitis? Eur Urol 2020;78:624-8.  Back to cited text no. 14
    
15.
Brian D, Harris M, Narasimhan M. Psychogenic polydipsia review: Etiology, differential, and treatment. Curr Psychiatry Rep 2007;9:236-41.  Back to cited text no. 15
    
16.
Clara OS, Winzeler B, Christ-Crain M. Primary polydipsia in the medical and psychiatric patient: Characteristics, complications and therapy. Swiss Med Wkly 2017;147:w14514.  Back to cited text no. 16
    
17.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in china. Int J Environ Res Public Health 2020;17:1729.  Back to cited text no. 17
    
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Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr 2020:52:102066.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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