Renal Functions of Enuretic and
Nonenuretic Children:
Hypernatriuria and Kaliuresis as
Causes of Nocturnal Enuresis

Vurgun, Nureddin; Gümüş, Bilal; Ece, Aydın; Arı, Zeki; Tarhan, Serdar; Yeter, Mustafa

doi:10.1159/000480886

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…Some pathophysiological studies explicating the basis have been published. The physiology of sleep, capacity and neurophysiology of the bladder, antidiuretic hormones (ADH) and sodium and potassium levels excreted in urine have been recently investigated (3,4). The effects of psychological factors are still unclear in these studies.…”

mentioning

confidence: 99%

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey

Gümüş¹,

Vurgun²,

Lekili³

et al. 1999

SPAE

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There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7-11 y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and nonenuretics with reference to breastfeeding, being firstborn or being right- or left-handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi-factorial aetiology. Child, family and physician co-operating together achieve the best help to both child and family.

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mentioning

confidence: 99%

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey

Gümüş¹,

Vurgun²,

Lekili³

et al. 1999

SPAE

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“…Patients with nocturia showed increased urine production associated with increased nocturnal sodium excretion. Enuretic patients had a significantly higher fractional excretion of sodium and potassium than normal [34]. There are significant correlations between the fractional excretion of sodium and potassium, and the frequency of bedwetting among enuretics [34].…”

Section: Effects Of Indomethacin In Primary Enuresis 297mentioning

confidence: 87%

“…Others showed no difference between enuretics and normal controls in the total diurnal urinary volume, osmolality or tubular capacity for reabsorption of water [34]. Moreover, there was no difference between enuretics and controls in urine production, ADH levels during the day and night or plasma osmolality [36].…”

Section: Effects Of Indomethacin In Primary Enuresis 297mentioning

confidence: 98%

“…Enuretic patients had a significantly higher fractional excretion of sodium and potassium than normal [34]. There are significant correlations between the fractional excretion of sodium and potassium, and the frequency of bedwetting among enuretics [34]. Diuresis during the night was 59% and solute excretion 49% higher in enuretics than in healthy children [35], mainly ascribed to an increase in sodium and magnesium ions.…”

Section: Effects Of Indomethacin In Primary Enuresis 297mentioning

confidence: 99%

“…The excretion of these ions is elevated not only during the night but also throughout 24 h in children with enuresis [35]. In addition, sodium and potassium excretions are higher in enuretics [34]. In response to fluid restriction, enuretics had significantly greater increases in plasma ADH than had comparable controls [31] and thus enuretic children had a higher secretion of ADH and did not have ADH deficiency [31].…”

Section: Effects Of Indomethacin In Primary Enuresis 297mentioning

confidence: 99%

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Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion

Al-Waili

2002

BJU International

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Objectives To assess urinary nitrite excretion, a stable end product of nitric oxide (NO), in patients with enuresis and in normal controls, and to evaluate the effects of indomethacin (a potent prostaglandin synthesis inhibitor) on urinary nitrite excretion, other urinary variables and bladder capacity. Patients and methods The study comprised 10 patients with primary enuresis and 10 normal comparable controls (age range 6-14 years). Nitrite was assayed in 'spot' morning urine samples in both the enuretics and normal controls. Enuretics were then given 50 mg indomethacin suppositories each night; urine volume, urinary osmolality and electrolytes, serum osmolality and electrolytes and urinary nitrite were assayed before indomethacin treatment and after 15 days of treatment. Results The mean (SD) urinary nitrite excretion was 24.4 (19.6) mmol/L in normal children and 275.9 (111.2) mmol/L in enuretics (P<0.05). With indomethacin, the urinary nitrite concentration was significantly decreased to 141 (45.1) mmol/L (P<0.05) and associated with a significant reduction in bed-wetting episodes and voiding frequency. The functional bladder capacity was <70% of the predicted value for age in six of the patients; they had significant improvements on indomethacin, to values similar to those in patients with a nearly normal functional bladder capacity. Indomethacin decreased the 24-h urinary volume by 41%, the night volume by 40%, clearance of free water by 46% and increased the day : night urinary volume ratio by 55%. The absolute amounts of urinary calcium, magnesium, phosphorus, urea, creatinine, and glucose were lower on indomethacin, although not statistically significantly so. Indomethacin decreased the 24-h urinary and 'spot' morning osmolality and osmotic clearance. There were no significant changes in serum osmolality and electrolyte concentrations. Indomethacin also decreased the absolute amount of urinary sodium, chloride and potassium, fractional sodium and potassium excretion, and filtered sodium. Creatinine clearance was decreased by 20% (P>0.05) and normal 24-h urinary protein was significantly lower, by 47%, after indomethacin treatment (P<0.05). Conclusion Urinary nitrite excretion increased significantly in patients with primary nocturnal enuresis; indomethacin markedly reduced bed-wetting episodes and decreased the frequency of voiding in enuretics with small or normal functional bladder capacity, which was associated with a significant decrease in urinary nitrite excretion. Indomethacin reduced bed-wetting by decreasing the urine volume, clearance of free water and urinary electrolytes, and through possible effects on bladder and urethral contraction, by inhibiting NO and prostaglandin synthesis. NO and prostaglandins might be important in the pathogenesis of primary enuresis.

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Adrenomedullin and nitrite levels in children with primary nocturnal enuresis

et al. 2002

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Primary nocturnal enuresis (PNE) is the most common type of nocturnal enuresis in children, but its etiology remains unclear. Recent studies indicated the differences in urinary electrolytes in enuretic children, and stressed the existence of a renal tubular maturation defect. In this study, 30 children (aged 6-12 years) with PNE were investigated in comparison with 18 healthy controls. We evaluated plasma antidiuretic hormone, electrolytes, 24-h urine volume, osmolarity, and urinary electrolytes. Unlike other studies, we firstly assessed the plasma and urinary adrenomedullin (AM) and total nitrite levels, a stable product of nitric oxide (NO), and investigated their relationship with urinary electrolytes. The plasma AM and total nitrite levels were significantly lower than controls. Urine volume (24-h) and potassium excretion were higher than in controls. However, 24-h urinary osmolarity and excretion of AM were significantly lower than in controls. Our results indicate that there may be a problem in renal regulation of potassium in children with PNE. Although decreased levels of AM and total nitrite may be a compensatory response to abnormal potassium and water excretion, further investigations are required to exclude whether the renal synthesis of AM and NO are also deficient in these children.

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Renal Functions of Enuretic and Nonenuretic Children: Hypernatriuria and Kaliuresis as Causes of Nocturnal Enuresis

Cited by 18 publications

References 17 publications

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey

Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion

Adrenomedullin and nitrite levels in children with primary nocturnal enuresis

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