Circadian Rhythm of Glomerular Filtration and Solute Handling Related to Nocturnal Enuresis

Abstract

We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to jumedia@elsevier.com. Abstract PURPOSEAlthough nocturnal polyuria in monosymptomatic enuresis (MNE) can largely be explained by the decreased nocturnal vasopressin secretion hypothesis, other circadian rhythms in the kidney also seem to play a role.Recently we documented an absent day/night rhythm in a subgroup of desmopressin (dDAVP) -refractory patients. The aim of this study was to explore the importance of abnormal circadian rhythm of glomerular filtration (GFR) and tubular (sodium, potassium) parameters in patients with MNE. MATERIALS AND METHODSThis retrospective study of a tertiary enuresis population collected data subsequent to a standardized screening (ICCS questionnaire, diary), 14 days diary for nocturnal enuresis and diuresis, and 24h concentration profile. The study population consisted of 139 children with nocturnal enuresis (NE) at least 5 years of age. The group of NMNE was used as control population for the children with MNE. RESULTSThere was a maintained circadian rhythm of GFR, sodium, osmotic excretion and diuresis-rate in both children with MNE and NMNE and there was no difference between the two groups. Secondary analysis revealed that in patients with nocturnal polyuria (both with MNE and NMNE), circadian rhythm of GFR, sodium, osmotic excretion and diuresis-rate was lost in contrast with patients without nocturnal polyuria (p<0.001). CONCLUSIONSCircadian rhythm of the kidney is not different between NMNE and MNE. However the subgroup of enuresis with nocturnal polyuria has a diminished circadian rhythm of nocturnal diuresis, sodiumexcretion and GFR in contrast with children without nocturnal polyuria. This observation cannot be explained by the vasopressin theory alone.

Urine metabolic phenotyping in children with nocturnal enuresis and comorbid neurobehavioral disorders

“…For instance, increased nocturnal sodium excretion, disturbances in hormones responsive for water and sodium handling (e.g. angiotensin II, aldosterone and atrial natriuretic factor), higher urinary excretion of renal autacoid prostaglandin E2, higher nocturnal blood pressure and decreased glomerular filtration rate (GFR) overnight were reported 33 , 34 .…”

Circadian regulation of renal function

“…Raes et al reported that loss of diurnal rhythms in urine volume are linked to reduced Na + excretion due to increased Na + reabsorption during the daytime in the proximal and distal tubules [197]. A recent study by Dossche et al proposed that nocturnal polyuria, whether it be in patients with nonmonosymptomatic or monosymptomatic nocturnal enuresis, resulted in diminished circadian rhythms of GFR and solute excretion [198]. …”

Tratamiento médico de la enuresis en niños: aspectos actuales

“…13 Actualmente se ha observado que en los pacientes con enuresis disminuye el ritmo circadiano de la uresis nocturna, excreción de sodio y filtración glomerular; sin embargo, este hallazgo carece de evidencia para soportar que la ADH es el único factor implicado. 14 Hasta el momento se desconocen las razones del inadecuado ciclo circadiano y los factores que lo producen, el aumento en la reacción de tratamiento y por qué el niño es incapaz de despertarse o levantarse para la micción al manifestar estas alteraciones.…”