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Desmopressin resistant nocturnal polyuria secondary to increased nocturnal osmotic excretion

Jo L Dehoorne1, Ann M Raes, Erik van Laecke

  • 1Pediatric Nephrology and Pediatric Urology Department, University Hospital Ghent, Belgium.

The Journal of Urology
|July 4, 2006
PubMed

Insights

Children with desmopressin-resistant nocturnal enuresis and nocturnal polyuria showed abnormal increased solute excretion, linked to fluid and dietary habits. Understanding these patterns is key for managing persistent bedwetting.

Area of Science:

  • Pediatrics
  • Nephrology
  • Urology

Background:

  • Nocturnal enuresis and nocturnal polyuria are common in children.
  • Desmopressin is a standard treatment, but some cases are resistant.
  • Understanding underlying mechanisms like solute excretion is crucial for treatment.

Purpose of the Study:

  • To investigate the role of increased solute excretion in children with desmopressin-resistant nocturnal enuresis and nocturnal polyuria.
  • To identify potential contributing factors to abnormal osmotic excretion in this patient group.

Main Methods:

  • Studied 42 children with monosymptomatic nocturnal enuresis and nocturnal polyuria unresponsive to desmopressin.
  • Collected 24-hour urine samples to measure volume, osmolality, osmotic excretion, and creatinine.
  • Compared findings with a control group of 100 children without enuresis.

Main Results:

  • Patients were categorized into three groups based on osmotic excretion patterns.
  • Group 1: Increased 24-hour osmotic excretion, likely diet-related (high renal osmotic load), associated with obesity.
  • Group 2: Increased evening/night osmotic excretion, linked to evening meal composition.
  • Group 3: Deficient daytime osmotic excretion due to fluid restriction for small bladder capacity.

Conclusions:

  • Abnormal increased osmotic excretion is associated with desmopressin-resistant nocturnal enuresis and nocturnal polyuria.
  • Fluid and dietary habits, including daytime fluid restriction and high protein/salt intake, may explain these excretion patterns.
Abstract

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