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Defect of osmoregulatory renal function in nocturnal enuresis
1I. M. Sechenov Institute of Evolutionary Physiology and Biochemistry, St. Petersburg, Russia.
Insights
Children with primary nocturnal enuresis (PNE) show altered kidney function, specifically increased nighttime diuresis and solute excretion. Desmopressin treatment normalized these functions and significantly reduced bedwetting episodes in most children.
Area of Science:
- Pediatric Nephrology
- Urology
- Endocrinology
Background:
- Primary nocturnal enuresis (PNE) affects numerous children, often linked to underlying renal functional disturbances.
- Understanding the specific renal mechanisms during PNE is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate renal function in children with PNE compared to healthy controls.
- To evaluate the efficacy of desmopressin (Adiuretin-SD) in normalizing renal function and treating PNE.
Main Methods:
- Comparative analysis of renal function parameters (diuresis, ion excretion) in 62 children with PNE and 20 controls (aged 6-15).
- Administration of intranasal desmopressin (Adiuretin-SD) and assessment of its effects on nocturnal diuresis and solute excretion.
- Monitoring of enuresis symptoms (dryness, reduction in wet nights) during desmopressin treatment.
Main Results:
- Children with PNE demonstrated elevated nocturnal diuresis, free water reabsorption, and solute excretion (Na+, Mg2+) versus controls.
- Intranasal desmopressin significantly reduced diuresis and ion excretion to normal levels.
- Treatment resulted in complete dryness in 61% of children and a 50% reduction in wet nights for 24%.
Conclusions:
- A decrease in ion reabsorption in the thick ascending Henle's loop is implicated in PNE pathogenesis, leading to increased tubular fluid load and diuresis.
- Desmopressin treatment addresses the principal defect in renal tubular function, offering a pathogenically justified approach for PNE.
- Desmopressin is an effective therapeutic option for managing primary nocturnal enuresis by correcting underlying renal functional abnormalities.
Abstract:
Renal function was studied in 62 children with primary nocturnal enuresis (PNE) and in 20 healthy children aged 6-15 years. During the night, children with PNE exhibited an increase in diuresis, free water reabsorption and solute excretion (including sodium and magnesium) in comparison to controls. Intranasal administration of Adiuretin-SD (10.5-24.5 micrograms) in the evening reduced diuresis and ion excretion to normal levels. During the treatment, 61% of the children became completely dry and, in 24% of the children, the number of wet nights was reduced by 50%. It is suggested that in the pathogenesis of PNE, the decrease in ion reabsorption in the thick ascending Henle's loop--resulting in a greater load of tubular fluid in the collecting ducts, an elevation of diuresis and increases in free water reabsorption and solute excretion--plays the leading role in disturbing renal function. Treatment of PNE with desmopressin is pathogenically justified, as it eliminates the principal defect of renal tubular function.