Defect of osmoregulatory renal function in nocturnal enuresis

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.