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Circadian rhythm of water and solute excretion in nocturnal enuresis.

Authors
  • Karamaria, Sevasti1, 2
  • Dossche, Lien1, 2
  • Delens, Vincent1
  • Degraeuwe, Eva1
  • Raes, Ann1, 2
  • Mauel, Reiner3
  • Vande Walle, Caroline2
  • Everaert, Karel4
  • Vande Walle, Johan5, 6
  • 1 Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium. , (Belgium)
  • 2 Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 3 Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium. , (Belgium)
  • 4 Department of Urology, Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 5 Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium. [email protected] , (Belgium)
  • 6 Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium. [email protected] , (Belgium)
Type
Published Article
Journal
Pediatric Nephrology
Publisher
Springer-Verlag
Publication Date
Mar 01, 2023
Volume
38
Issue
3
Pages
771–779
Identifiers
DOI: 10.1007/s00467-022-05645-8
PMID: 35748940
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Nocturnal polyuria (NP) due to a suppressed vasopressin circadian rhythm is a well-documented pathogenetic mechanism in enuresis, mainly studied in monosymptomatic enuresis. A substantial percentage of patients do not respond to desmopressin. This suggests that NP may not only be related to vasopressin, but that other kidney components play a role. Solute handling and osmotic excretion have been investigated in the past, especially in refractory patients. Nevertheless, data in treatment-naïve populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naïve patients with or without NP, with emphasis on circadian rhythms. Retrospective analysis of 403 treatment-naïve children 5-18 years with severe enuresis (> 8 nights/2 weeks). Circadian rhythms were evaluated by a 24-h urine collection in 8 timed portions (4 day, 4 nighttime) at in-home settings. Urine volume, osmolality, and creatinine were measured. Patients were subdivided into three groups according to nocturnal diuresis (ND) and Expected Bladder Capacity (EBCage) ratio: (a) < 100%, (b) 100-129%, (c) > 130%. All groups maintained circadian rhythm for diuresis and diuresis rates. Patients with higher ND (100-129% and > 130% EBCage) had higher daytime volumes and less pronounced circadian rhythm. In the ND group > 130% EBCage, the ND rate was higher during the first night collection and osmotic excretion was significantly higher overnight. Overall 24-h fluid intake (reflected by 24-h diuresis) and nutritional intake (24-h osmotic excretion) might play a role in enuresis. Increased diuresis rate early in the night can be important in some patients, whereas the total night volume can be important in others. A higher resolution version of the Graphical abstract is available as Supplementary Information. © 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.

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