SPECIAL FEATURE Patient-Centered Focused Review| Volume 364, ISSUE 2, P229-236, August 2022

Pathophysiologic approach to understanding and successfully treating idiopathic edema: Unappreciated importance of nocturia


      Idiopathic edema (IE), a disorder of females, is characterized by edema and weight gains exceeding 1.4 kg while assuming an upright position followed by nocturia and returning to a non-edematous baseline weight in the morning. There is no successful treatment of IE and the importance of nocturia needs to be emphasized. The major underlying abnormality is an increase in vascular membrane permeability (VMP). We present four cases with differing degrees of IE who were successfully managed by manipulating Starling's forces. While we could not alter the increase in VMP, manipulating oncotic and hydrostatic pressures between both compartments were untenable except to decrease intravascular hydrostatic pressure by sodium restriction. All four cases virtually eliminated daily weight gains and nocturia to improve quality of life considerably, two with the assistance of daily hydrochlorothiazide (HCTZ) and all four by furosemide to accelerate recovery from the weight gain to permit occasional dietary indiscretions to improve quality of life. Two cases with milder forms of IE did not quantify sodium intake as meticulously as cases one and four, who appeared to have greater increases in VMP. IE can be treated successfully by sodium restriction with or without use of HCTZ and furosemide to eliminate the distressing edema, weight gain and nocturia with marked improvement in emotional instability after understanding that the weight gains and nocturia were linked to dietary intake of sodium.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kay A.
        • Davis C.L.
        Idiopathic edema. in-depth-review.
        Am J Kidney Dis. 1999; 34: 405-423
        • Edwards O.M.
        • Bayliss R.I.S.
        Idiopathic oedema of women.
        Quart J Med. 1976; (XLV): 125-144
        • Streeten C.H.P.
        Idiopathic edema: pathogenesis, clinical features, and treatment.
        Metabolism. 1978; 27: 353-383
      1. Sterns RH, Emmett M,Forman JP. IdiopathicEdema. In UpToDate, literature review current through Feb. 2022

        • Thorn G.
        Approach to the patient with “Idiopathic edema” or “periodic swelling”.
        JAMA. 1968; 206: 333-338
        • McKendry J.B.
        Idiopathic edema.
        Can Nurse. 1973; 69: 41-43
        • de Wardner H.E.
        Idiopathic edema: role of diuretic abuse.
        Kidney Int. 1981; 19: 881-892
        • Coleman M.
        • Horwith M.
        • Brown J.L.
        Idiopathic edema. Studies demonstrating protein-leaking angiopathy.
        Am J Med. 1970; 49: 104-113
        • Starling E.H.
        Contributions to the physiology of lymph secretion.
        Jr Physiol. 1893; 14: 131-153
        • Epstein M.
        Renal effects of head-out water immersion in humans: a 15-year update.
        Phys Rev. 1992; 72: 563-593
      2. Valtin H. Renal Dysfunction: Mechanisms involved in fluid and solute imbalance: Edema; mechanisms involved in the fluid and solute imbalance. Little Brown & Co; 1979:58-59.

        • Abuelo J.G.
        Normotensive ischemic acute renal failure.
        N Engl J Med. 2007; 357 ([PMID: 17715412 DOI]): 797-805
        • Stricker E.M.
        • Verbalis J.
        • Squire L.E.
        • Roberts J.L.
        • Spitzer N.C.
        • Zigmond M.J.
        • McConnell S.K.
        • Bloom F.E.
        Water intake and body fluids.
        Fundamental Neuroscience. 2nd ed. Elsevier, California2003: 1011-1029
        • Streeten H.P.
        • Louis L.H.
        • Conn J.W.
        Secondary aldosteronism in “Idiopathic edema.
        Trans Assoc Am Phys. 1960; 73: 227-239
        • Maesaka J.K.
        • Imbriano L.
        • Miyawaki N.
        Determining fractional urate excretion rates in hyponatremic conditions and improved methods to distinguish cerebral/renal salt wasting from the syndrome of inappropriate secretion of antidiuretic hormone.
        Front Med. 2018; 5 (November article 319)319
        • Tian Y.
        • Sandberg K.
        • Murase T.
        • Baker E.A.
        • Speth R.C.
        • Verbalis J.G.
        Vasopressin V2 receptor binding is down-regulated during renal escape from vasopressin-induced antidiuresis.
        Endocrinology. 2000; 141: 307-314
        • Mohring J.
        • Mohring B.
        Reevaluation of DOCA escape phenomenon.
        Am J Physiol. 1972; 223: 1237-1245
        • Maesaka J.K.
        • Imbriano L.J.
        • Pinkhasov A.
        • et al.
        Identification of a novel natriuretic protein in patients with cerebral-renal salt wasting - implications for enhanced diagnosis.
        Am J Med Sci. 2021; 361 (Please note change in title-): 261-268
        • Ellison D.H.
        • Felker G.M.
        Diuretic treatment in heart failure.
        N Engl J Med. 2017; 377: 1964-1975
        • Clarkson B.
        • Thompson D.
        • Horwith M.
        • Luckey H.
        Cyclical edema and shock due to increased capillary permeability.
        Am J Med. 1960; 29: 193-216
        • Engel T.
        • Jewelewicz R.
        • Dyrenfurth I.
        • Speroff L.
        • Vande Wiele R.L.
        Ovarian hyperstimulation syndrome. Report of a case with notes on pathogenesis and treatment.
        Am J Obstet Gynecol. 1972; 112: 1052-1060