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Osmoregulation and desmopressin pharmacokinetics in enuretic children
T Nevéus1, G Läckgren, T Tuvemo
1Unit for Pediatric Internal Medicine, Uppsala University Children's Hospital, Uppsala, Sweden.
Insights
Desmopressin treatment for nocturnal enuresis showed no differences in drug pharmacokinetics or renal effects between responders and nonresponders. However, nonresponders had smaller bladder volumes and produced more concentrated urine.
Area of Science:
- Pediatric Nephrology
- Pharmacology
Background:
- Nocturnal enuresis affects children's quality of life.
- Desmopressin is a common treatment for nocturnal enuresis.
Purpose of the Study:
- To compare desmopressin pharmacokinetics and renal effects in children who respond versus those who do not respond to antienuretic treatment.
Main Methods:
- Twelve children with nocturnal enuresis were divided into responders (6) and nonresponders (6) to desmopressin.
- Desmopressin (2 mg IV) pharmacokinetics and 24-hour urine parameters were monitored.
- A thirst provocation test was conducted on 10 patients.
Main Results:
- No significant differences in desmopressin pharmacokinetics or nocturnal urine production/osmolality were observed between groups.
- Responders produced more urine with lower osmolality during the day post-injection compared to nonresponders.
- Nonresponders exhibited smaller bladder volumes and produced more concentrated urine during thirst tests.
Conclusions:
- Desmopressin pharmacokinetics and renal effects do not differentiate treatment responders from nonresponders.
- Smaller bladder capacity and more concentrated urine output characterize nonresponders to desmopressin therapy.
Objective:
The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug.
Methods:
Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test.
Results:
Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 +/- 0.84 and 0.77 +/- 0.20 mL/kg/h; urine osmolality, 558 +/- 271 and 883 +/- 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 +/- 0.68 mL/kg body weight) than responders (4.70 +/- 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 +/- 185 and 922 +/- 217 mOsm/kg, respectively).
Conclusion:
Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.