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Vasopressin deficiency in primary nocturnal enuresis. Results of a controlled prospective study
J Steffens1, M Netzer, E Isenberg
1Department of Urology, University of Saarland, Homburg, FRG.
Insights
Some children with primary nocturnal enuresis (PNE) have low arginine vasopressin (AVP). Nocturnal urine osmolality may indicate this deficiency and predict successful desmopressin treatment outcomes.
Area of Science:
- Pediatric endocrinology
- Urology
- Circadian biology
Background:
- Primary nocturnal enuresis (PNE) is often associated with disrupted circadian rhythms of arginine vasopressin (AVP).
- Current diagnostic protocols for AVP deficiency are complex and require significant patient and parental compliance.
Purpose of the Study:
- To introduce a simplified screening test for identifying AVP deficiency in children with PNE.
- To evaluate the efficacy of intranasal synthetic vasopressin treatment in children with PNE and suspected AVP deficiency.
Main Methods:
- Radioimmunoassay (RIA) was used to measure plasma AVP levels in 55 children with PNE and 15 controls over 72 hours under controlled hydration.
- Nocturnal urine volume and osmolality were also assessed.
- Treatment response to desmopressin was monitored.
Main Results:
- Twenty-five percent of children with PNE exhibited decreased nocturnal AVP levels compared to controls.
- This group also showed increased nocturnal urine volume and lower urine osmolality.
- Eight patients had concomitant bladder instability.
- Desmopressin treatment resulted in dryness in 64.3% of patients with AVP deficiency, but only 14.3% remained dry after discontinuation.
Conclusions:
- Nocturnal urine osmolality measurement may serve as a practical indicator of AVP deficiency in children with PNE.
- Identifying AVP deficiency can help predict a positive response to desmopressin therapy for nocturnal enuresis.
Abstract:
The lack of circadian rhythmicity of plasma arginine vasopressin (AVP) in primary nocturnal enuresis (PNE) in some children is known. The original test protocol is time-consuming and needs excellent compliance by children and parents. The goals of the presented study are the introduction of a simple screening test and the evaluation of the response of treatment using intranasal synthetic vasopressin. Fifty-five children (aged 8.2 +/- 3.1 years) with PNE and 15 children (aged 7.9 +/- 2.4 years) of a control group were investigated. Using a standardized protocol, AVP levels were measured by radioimmunoassay (RIA) under controlled water intake 3 times per day over a period of 72 h. Fourteen of 55 tested children (25.5%) with PNE had a significant decrease in nocturnal AVP when compared to the control group. We measured also an increased nocturnal urine volume and a lower urine osmolality in this enuretic group. Eight of 14 patients (57.1%) with plasma AVP deficiency (AVPD) also had bladder instability. Nine of 14 patients (64.3%) with AVPD with or without concomitant bladder instability were totally dry during desmopressin treatment, but only 2 (14.3%) remained dry after discontinuation of treatment. Our data suggest that nocturnal urine osmolality measurement may reflect AVPD and predict a positive treatment outcome.