Hypernatriuria and Kaliuresis in Enuretic Children and the Diurnal Variation

Vurgun, Nureddin; Yiditodlu, M. Ramazan; Ypcan, Akin; Ari, Zeky; Tarhan, Serdar; Balkan, Can

doi:10.1016/s0022-5347(01)63611-5

Cited by 22 publications

(3 citation statements)

References 17 publications

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“…16 Sodium and potassium urinary output has also been studied in the enuretic population. 17 Calciuria has recently been demonstrated as significantly increased in nocturnal diuresis of MNE, mostly associated with nocturnal polyuria. 7,8,18 Hypercalciuria could have a pivotal role in MNE, and has been associated with nocturnal polyuria in 43% of bedwetters without diurnal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

et al. 2004

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Purpose: We verify the sodium fraction excretion rate (FE Na) and potassium fraction excretion (FE K) rates in monosymptomatic nocturnal enuresis. We also correlate FE Na and FE K to urinary osmolality, nocturnal polyuria and vasopressin in the same population.Materials and Methods: A total of 438 children 6 to 15 years old (mean age 9.7) presenting with monosymptomatic nocturnal enuresis were recruited from different centers. Inclusion criteria were 3 or greater wet nights a week, no daytime incontinence and no treatment in the previous 2 months. Exclusion criteria were cardiopathy, endocrinopathy, psychiatric problems and urinary tract abnormalities. Micturition chart, diurnal (8 am to 8 pm) and nocturnal (8 pm to 8 am) urine collection, including separate diuresis volumes, (Na, K and Ca) electrolytes and osmolality were evaluated, as well as serum electrolytes, creatinine and nocturnal (4 am) vasopressin. Diurnal and nocturnal FE K and FE Na were calculated. ANOVA test, chi-square test, Student's t test and Pearson correlation test were used for statistical analysis.Results: Nocturnal polyuria (diurnal to nocturnal diuresis ratio less than 1) was found in 273 children (62.3%, group 1 and nocturnal urine volumes were normal in 165 with enuresis (37.7%, group 2). Nocturnal FE Na was abnormal in 179 children (40.8%), including 118 in group 1 (43.2%) and 61 in group 2 (36.9%) (chi-square not significant). FE Na was also increased in nocturnal versus daytime diuresis (Student's t test p Ͻ0.001). In group 1 nocturnal FE Na correlated with nocturnal diuresis (Pearson correlation p ϭ 0.003, r ϭ ϩ0.175), while daytime FE Na and nocturnal FE Na correlated with diurnal diuresis (Pearson correlation p ϭ 0.001, r ϭ ϩ0.225 and Pearson correlation p ϭ 0.001, r ϭ ϩ0.209, respectively). In group 2 nocturnal FE Na did not correlate with diuresis (Pearson correlation p ϭ 0.103, r ϭ ϩ0.128) but correlated with vasopressin values (Pearson correlation p ϭ 0.042, r ϭ Ϫ0.205). Urine osmolality was reduced in 140 children (31.9%) and correlated with nocturnal diuresis (Pearson correlation p ϭ 0.003, r ϭ Ϫ0.321). Vasopressin was decreased in 332 children (75.8%, 62.6% in group 1 and 13.2% in group 2). No significant difference was found between sexes and age of enuretic subgroups.Conclusions: Nocturnal FE Na correlates with nocturnal diuresis, whereas daytime FE Na does not. FE K in daytime and nighttime diuresis does not statistically differ in nocturnal polyuric and nonpolyuric enuretic groups. Osmolality correlates with nocturnal diuresis, and vasopressin at 4 am was lower in the nocturnal polyuric group. The hypothesis of a subset of enuretic patients presenting with nocturnal polyuria associated with high nocturnal natriuria and low vasopressin values has been confirmed. KEY WORDS: enuresis, polyuria, vasopressins, electrolytes, desmopressin Pathogenesis of monosymptomatic nocturnal enuresis (MNE) is still debated as different etiopathogenetic hypotheses have been proposed, accepted or rejected during the last century....

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Section: Discussionmentioning

confidence: 99%

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

et al. 2004

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“…It was now shown in a group of bed-wetting children that they lacked the physiological nocturnal peak of vasopressin secretion and had a nocturnal urine production exceeding their functional bladder capacity (Nrgaard et al, 1985). The possibility has also been put forward that the polyuria is not necessarily always caused by vasopressin deficiency (Vurgun et al, 1998 A problem with this hypothesis is the finding that nocturnal polyuria is not exclusive to bed-wetters. The possibility has also been put forward that the polyuria is not necessarily always caused by vasopressin deficiency (Vurgun et al, 1998 A problem with this hypothesis is the finding that nocturnal polyuria is not exclusive to bed-wetters.…”

Section: Nocturnal Polyuriamentioning

confidence: 99%

Sleep enuresis

Nevéus

2011

Handbook of Clinical Neurology

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“…Conflicting evidence has also been published about the possible vasopressin deficiency of bedwetters [8,9], and solute diuresis as well as water diuresis has been implicated to characterize the polyuria of these children [10,11]. If the polyuria were caused by a lack of vasopressin, water diuresis would be ubiquitous.…”

Section: Introductionmentioning

confidence: 99%

Vasopressin and hypercalciuria in enuresis: a reappraisal

Nevéus

Hansell²,

Stenberg

2002

BJU International

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Objective To test the hypotheses that vasopressin deficiency or hypercalciuria are important in polyuric and non-polyuric bedwetting, as nocturnal polyuria is a pathogenetic factor in enuresis responsive to antidiuretic therapy with desmopressin. Subjects and methods Vasopressin deficiency has been implicated as a cause of nocturnal polyuria, but measurements of vasopressin in plasma have given contradictory results, because the hormone is released in pulses. Urinary levels reflect the secretion over longer periods. Hypercalciuria has also been proposed as a pathogenetic factor. Twenty-eight enuretic children who responded to desmopressin therapy with or without added anticholinergic agents (diuresis-dependent enuresis, DE), 15 children with therapy-resistant enuresis (not diuresis-dependent, NDE) and 51 continent controls were assessed. Urinary vasopressin, calcium and osmolality were measured in the morning after a 12-h thirst provocation. Urine production was recorded for 2 days.Results Because most data were not normally distributed, the values are expressed as the median (range). There were no differences in urine osmolality; i.e.

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Hypernatriuria and Kaliuresis in Enuretic Children and the Diurnal Variation

Cited by 22 publications

References 17 publications

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

Sleep enuresis

Vasopressin and hypercalciuria in enuresis: a reappraisal

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