@article{8758551,
  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-naive populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naive patients with or without NP, with emphasis on circadian rhythms.

Methods Retrospective analysis of 403 treatment-naive 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.}},
  author       = {{Karamaria, Sevasti and Dossche, Lien and Delens, Vincent and Degraeuwe, Eva and Raes, Ann and Mauel, Reiner and VANDE WALLE, CAROLINE and Everaert, Karel and Vande Walle, Johan}},
  issn         = {{0931-041X}},
  journal      = {{PEDIATRIC NEPHROLOGY}},
  keywords     = {{Nephrology,Pediatrics,Perinatology and Child Health,Enuresis,children,circadian rhythm,osmotic excretion,diuresis rate,GLOMERULAR-FILTRATION,URINE PRODUCTION,POLYURIA,DESMOPRESSIN,CHILDREN,MANAGEMENT,DIURESIS,SLEEP,STANDARDIZATION,DEFINITIONS}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{771--779}},
  title        = {{Circadian rhythm of water and solute excretion in nocturnal enuresis}},
  url          = {{http://doi.org/10.1007/s00467-022-05645-8}},
  volume       = {{38}},
  year         = {{2023}},
}

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