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The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology

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Abstract

Nocturnal polyuria in monosymptomatic nocturnal enuresis (MNE) has so far mainly been attributed to a disturbed circadian rhythm of renal water handling. Low vasopressin levels overnight correlate with absent maximal concentrating activity, resulting in an increased nocturnal diuresis with low urinary osmolality. Therefore, treatment with desmopressin is a rational choice. Unfortunately, 20 to 60 % of children with monosymptomatic enuresis are desmopressin-resistant. There is increasing evidence that other disturbed circadian rhythms might play a role in nocturnal polyuria. This review focuses on renal aspects in the pathophysiology of nocturnal polyuria in MNE, with special emphasis on circadian rhythms. Articles related to renal circadian rhythms and enuresis were searched through the PubMed library with the goal of providing a concise review.

Conclusion: Nocturnal polyuria can only partially be explained by blunted circadian rhythm of vasopressin secretion. Other alterations in the intrinsic renal circadian clock system also seem to be involved, especially in desmopressin-resistant enuresis.

What is Known:

• Disturbance in the circadian rhythm of arginine vasopressin secretion is related to nocturnal polyuria in children with enuresis.

• Desmopressin is recommended as a treatment for monosymptomatic nocturnal enuresis, working as a vasopressin analogue acting on V2 receptors in the collecting ducts of the kidney.

What is New:

• Other renal circadian rhythms might play a role in nocturnal polyuria, especially in desmopressin-resistant case.

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Abbreviations

AVP:

Arginine vasopressin

DDAVP:

Desmopressin

EBC:

Expected bladder capacity

FBC:

Functional bladder capacity

GFR:

Glomerular filtration rate

ICCS:

International Children’s Continence Society

LUT:

Lower urinary tract

MVV:

Maximum voided volume

MNE:

Monosymptomatic nocturnal enuresis

NMNE:

Non-monosymptomatic nocturnal enuresis

NP:

Nocturnal polyuria

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Author’s contributions

L. Dossche performed the literature search, drafted the initial manuscript and revised the subsequent drafts.

J. Vande Walle critically reviewed the drafts.

C. Van Herzeele conceptualized the study and critically reviewed and revised the manuscript.

All authors approve the final manuscript as submitted.

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Authors and Affiliations

  1. Department of Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    L. Dossche, J. Vande Walle & C. Van Herzeele

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  1. L. Dossche
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  2. J. Vande Walle
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  3. C. Van Herzeele
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Correspondence to L. Dossche.

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Funding

This study was funded by the “Agency for Innovation by Science and Technology in Flanders (IWT)” through the “SAFE-PEDRUG” project (IWT-SBO 130033).

Conflict of interest

L. Dossche declares that she has no conflict of interest. J. Vande Walle is a lecturer, investigator and advisor for the Ferring Pharmaceuticals (no conflict of interest). C. Van Herzeele declares that she has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Mario Bianchetti

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Dossche, L., Walle, J.V. & Van Herzeele, C. The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology. Eur J Pediatr 175, 747–754 (2016). https://doi.org/10.1007/s00431-016-2729-3

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