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Circadian rhythm of water and solute excretion in nocturnal enuresis

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Abstract

Background

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.

Methods

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%.

Results

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.

Conclusions

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.

Graphical abstract

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

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Abbreviations

AAP:

American Academy of Pediatrics

BMI:

Body mass index

BSA:

Body surface area

DSWPD:

Delayed sleep–wake phase disorder

EAU:

European Association of Urology

EBCage:

Expected bladder capacity for age

ESPN:

European Society of Pediatric Nephrology

ESPU:

European Society of Pediatric Urology

ICCS:

International Children’s Continence Society

IPNA:

International Pediatric Nephrology Association

LUTS:

Lower urinary tract symptoms

MNE:

Monosymptomatic enuresis

ND:

Nocturnal diuresis

NE:

Nocturnal enuresis

NP:

Nocturnal polyuria

NMNE:

Non-monosymptomatic enuresis

OAB:

Overactive bladder

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Author information

Authors and Affiliations

  1. Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium

    Sevasti Karamaria, Lien Dossche, Vincent Delens, Eva Degraeuwe, Ann Raes & Johan Vande Walle

  2. Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium

    Sevasti Karamaria, Lien Dossche, Ann Raes, Caroline Vande Walle & Johan Vande Walle

  3. Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium

    Reiner Mauel

  4. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Karel Everaert

Authors
  1. Sevasti Karamaria
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  2. Lien Dossche
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  3. Vincent Delens
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  4. Eva Degraeuwe
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  9. Johan Vande Walle
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Contributions

SK collected the data, performed the statistical analyses, performed the measurements, and wrote the first draft of the manuscript. JVW conceived the study, collected data, revised the manuscript, and contributed as last author. KE, AR, LD, CVW, RM, ED, and VD revised the manuscript.

Corresponding author

Correspondence to Johan Vande Walle.

Ethics declarations

Ethics approval

The study protocol was approved by the ethics committee of Ghent University Hospital (BC-07877, 25JUN2020) and was carried out following the principles of the Declaration of Helsinki and the GCP/ICH/GDPR guidelines.

Consent to participate

Informed consent was obtained from the guardians/parents of all participants and assent from the participants where applicable.

Consent for publication

Not applicable (no images/photos of participants published).

Conflict of interest

JVW is a member of the advisory board, invited speaker, and PI of industry-sponsored studies of Astellas and Ferring. KE has received honoraria and grants to the institution from Ferring, Astellas, and Medtronic; he is a minority shareholder without salary from P2Solutions (smart textile applications). The rest of the authors declare that they have no conflict of interest.

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Cite this article

Karamaria, S., Dossche, L., Delens, V. et al. Circadian rhythm of water and solute excretion in nocturnal enuresis. Pediatr Nephrol 38, 771–779 (2023). https://doi.org/10.1007/s00467-022-05645-8

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  • DOI: https://doi.org/10.1007/s00467-022-05645-8

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