Details

Autor(en) / Beteiligte

• Karamaria, Sevasti
• Dossche, Lien
• Delens, Vincent
• Degraeuwe, Eva
• Raes, Ann
• Mauel, Reiner
• Vande Walle, Caroline
• Everaert, Karel
• Vande Walle, Johan

Titel

Circadian rhythm of water and solute excretion in nocturnal enuresis

Ist Teil von

• Pediatric nephrology (Berlin, West), 2023-03, Vol.38 (3), p.771-779

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2023

Quelle

SpringerLink

Beschreibungen/Notizen

• Background 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. Methods 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%. Results 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. Conclusions 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. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary Information .