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Plasma vasopressin and response to treatment in primary nocturnal enuresis
Insights
Children
Area of Science:
- Pediatrics
- Endocrinology
- Urology
Background:
- Primary monosymptomatic nocturnal enuresis (PMNE) affects many children.
- Treatment with 1-desamino-8-D-arginine vasopressin (DDAVP) is common but not universally effective.
Purpose of the Study:
- To investigate the relationship between nocturnal vasopressin release and treatment response to DDAVP in children with PMNE.
- To identify predictors of DDAVP treatment success in this population.
Main Methods:
- Overnight blood sampling to measure vasopressin (AVP) concentrations every 15 minutes.
- Recruitment from a specialized enuresis clinic with a defined treatment protocol.
Main Results:
- A quadratic relationship was observed between mean plasma AVP and DDAVP response; both very high and very low AVP levels were associated with unresponsiveness.
- Plasma AVP profiles varied significantly, from low with little variability to high with wide variability.
Conclusions:
- DDAVP treatment response is linked to endogenous AVP production patterns.
- Predictors of successful DDAVP treatment include breastfeeding history, mean nocturnal AVP, and child's height.
- Poor birth weight and linear growth negatively impacted treatment response, suggesting diverse etiologies for nocturnal enuresis based on AVP release patterns.
Aims:
To examine the relation between nocturnal vasopressin release and response to treatment with the vasopressin analogue 1-desamino-8-D-arginine vasopressin (DDAVP) in children with primary monosymptomatic nocturnal enuresis.
Design:
Children were recruited from a specific enuresis clinic and entered into a defined treatment programme. Nocturnal vasopressin concentrations were measured every 15 minutes over a four hour period during overnight admission.
Results:
Sixty seven children were eligible for entry into the study, 35 of whom agreed to overnight sampling. There was a quadratic relation between mean plasma AVP and response to treatment with DDAVP, with very high or very low concentrations being unresponsive. Plasma AVP profiles ranged from low concentrations with little variability to high concentrations with wide variability.
Conclusion:
The ability to respond to DDAVP is related to endogenous AVP production and is influenced by neuronal patterning in early infancy. The best predictors of success with treatment were a past history of breast feeding, mean nocturnal AVP concentration, and the height of the child. The response was adversely affected by poor weight at birth and poor linear growth. The study suggests differing causes of nocturnal enuresis related to different patterns of AVP release.