Nocturnal enuresis can be caused by absorptive hypercalciuria

Area of Science:

• Pediatric Nephrology
• Urology
• Endocrinology

Background:

• Primary monosymptomatic nocturnal enuresis (NE) affects numerous children globally.
• The etiology of NE is multifactorial, with various contributing factors under investigation.
• Absorptive hypercalciuria has been suggested as a potential, though not widely recognized, cause of NE.

Purpose of the Study:

• To investigate the potential causal link between absorptive hypercalciuria and primary monosymptomatic nocturnal enuresis.
• To evaluate the efficacy of a combined therapeutic approach involving dietary modifications and DDAVP in treating NE associated with hypercalciuria.

Main Methods:

• A cohort of 406 patients with primary NE was retrospectively analyzed.
• Urinary calcium and creatinine levels were assessed, identifying 21 patients with significantly elevated values.
• These patients underwent Pak's test, parathyroid hormone (PTH), and antidiuretic hormone (ADH) measurements, followed by a 3-month treatment protocol.

Main Results:

• Pak's test confirmed absorptive hypercalciuria in all 21 patients; PTH and ADH levels were normal.
• Following dietary intervention, 19% of patients achieved complete resolution of NE.
• Combined treatment with diet and DDAVP led to complete enuresis cessation and normalized calciuria levels in the remaining patients.

Conclusions:

• Absorptive hypercalciuria is identified as a significant contributing factor to primary nocturnal enuresis.
• A therapeutic strategy combining dietary changes and DDAVP demonstrates high efficacy in managing NE secondary to absorptive hypercalciuria.
• This study highlights the importance of considering metabolic factors like hypercalciuria in the differential diagnosis of persistent NE.