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Urine concentration and enuresis in healthy preschool children
R A Mevorach1, G A Bogaert, B A Kogan
1Department of Urology, University of California School of Medicine-San Francisco.
Insights
Healthy children aged 3-6 can concentrate urine overnight. First morning urine specific gravity accurately predicts nocturnal enuresis (bedwetting), guiding diagnosis and treatment.
Area of Science:
- Pediatric Nephrology
- Urology
- Child Health
Background:
- Nocturnal enuresis, or bedwetting, affects many children.
- Assessing urine concentrating ability is key in evaluating enuresis.
Purpose of the Study:
- To determine if healthy children concentrate urine overnight.
- To correlate first morning urine specific gravity with bedwetting history and habits.
Main Methods:
- Prospective, observer-blinded study of 47 healthy children (ages 3-6).
- Collected first morning urine specimens.
- Administered questionnaires on voiding habits and continence.
Main Results:
- 40/47 children had urine specific gravity >1.020, indicating urine concentration.
- Children with specific gravity ≤1.015 were more likely to have a history of bedwetting and wet the bed during the study.
- High voiding frequency correlated with increased bedwetting risk.
Conclusions:
- Healthy young children can concentrate their urine overnight.
- Urine specific gravity is a reliable indicator for nocturnal enuresis in children.
- Morning urine specific gravity and patient history should guide enuresis evaluation and treatment.
Objectives:
To determine whether children concentrate their urine overnight and to assess the correlation between specific gravity of a first morning urine specimen and the results of a questionnaire concerning bedwetting, voiding habits, and continence in 47 healthy children aged 3 to 6 years.
Design:
A prospective observer-blinded consecutive sample.
Setting:
Two San Francisco, Calif., preschools.
Participants:
Forty-seven children attending preschool during the study period.
Measurements/Main Results:
Forty of 47 children had a urine specific gravity greater than 1.020. None of these children wet the bed during this study, although four (11%) of 36 had a history of bedwetting. Furthermore, seven children with a urine specific gravity of 1.015 or lower had a history of bedwetting and wet the bed during this study. A voiding frequency of six or more times per day, by history, was associated with a 3:1 relative risk of bedwetting but did not segregate children with primary enuresis from those with secondary enuresis.
Conclusions:
Our results indicate that healthy children aged 3 to 6 years are able to concentrate their urine. In addition, urine specific gravity was an accurate predictor of the presence of nocturnal enuresis in this group of children. Our results suggest that a specific gravity of the first morning urine specimen should be correlated with appropriate history before extensive diagnostic evaluation or empiric therapy is performed in children with nocturnal enuresis.