遗尿
利尿
昼夜节律
医学
内科学
内分泌学
抗利尿药
去氨加压素
尿渗透压
排泄
夜行的
加压素
尿钠
肾功能
泌尿科
作者
Sevasti Karamaria,Lien Dossche,Vincent Delens,Eva Degraeuwe,Ann Raes,Reiner Mauel,Caroline Vande Walle,Karel Everaert,Johan Vande Walle
标识
DOI:10.1007/s00467-022-05645-8
摘要
Nocturnal polyuria (NP) due to a suppressed vasopressin circadian rhythm is a well-documented pathogenetic mechanism in enuresis, mainly studied in monosymptomatic enuresis. A substantial percentage of patients do not respond to desmopressin. This suggests that NP may not only be related to vasopressin, but that other kidney components play a role. Solute handling and osmotic excretion have been investigated in the past, especially in refractory patients. Nevertheless, data in treatment-naïve populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naïve patients with or without NP, with emphasis on circadian rhythms. Retrospective analysis of 403 treatment-naïve children 5–18 years with severe enuresis (> 8 nights/2 weeks). Circadian rhythms were evaluated by a 24-h urine collection in 8 timed portions (4 day, 4 nighttime) at in-home settings. Urine volume, osmolality, and creatinine were measured. Patients were subdivided into three groups according to nocturnal diuresis (ND) and Expected Bladder Capacity (EBCage) ratio: (a) < 100%, (b) 100–129%, (c) > 130%. All groups maintained circadian rhythm for diuresis and diuresis rates. Patients with higher ND (100–129% and > 130% EBCage) had higher daytime volumes and less pronounced circadian rhythm. In the ND group > 130% EBCage, the ND rate was higher during the first night collection and osmotic excretion was significantly higher overnight. Overall 24-h fluid intake (reflected by 24-h diuresis) and nutritional intake (24-h osmotic excretion) might play a role in enuresis. Increased diuresis rate early in the night can be important in some patients, whereas the total night volume can be important in others. A higher resolution version of the Graphical abstract is available as Supplementary Information.
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