Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

Aceto, Gabriella; Rosa, Philippe; Delvecchio, Maurizio; Chiozza, Maria Laura; Cimador, Marcello; Caione, Paolo

doi:10.1097/01.ju.0000108420.89313.0f

Cited by 26 publications

(19 citation statements)

References 18 publications

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“…In recent studies, investigators observed increased nocturnal fractional sodium excretion in enuretic patients with polyuria, suggesting that sodium excretion is correlated with nocturnal polyuria and nocturnal enuresis [22–24]. In our study, we observed higher serum sodium concentrations in enuretic patients that had a lower day-to-night difference with respect to mean BP values.…”

Section: Discussionsupporting

confidence: 72%

Non-dipping phenomenon in children with monosymptomatic nocturnal enuresis

et al. 2013

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PurposeMonosymptomatic nocturnal enuresis is a common disorder seen in childhood, and many factors play a role in its etiopathology to varying degrees. The aim of our study was to investigate the possible association between nocturnal enuresis and 24-h blood pressure profiles of enuretic children.MethodsA total of 45 children ranging in age from 6 to 15 years with monosymptomatic nocturnal enuresis and 22 age-matched healthy controls were enrolled in our study. The blood pressure measurement was made at 30-min intervals during a 24-h period via an ambulatory blood pressure measurement device. Both groups underwent medical tests that included a complete blood count, blood biochemistry profile, urinalysis and blood renin–aldosterone levels, and all study subjects received an abdominal ultrasound.ResultsStatistically significant high nocturnal blood pressure levels were observed in our patients with monosymptomatic nocturnal enuresis compared with the control group (p < 0.05). The mean values of the day-to-night difference (dipping) in the systolic and diastolic blood pressure of the patients were significantly lower than those of control group (p < 0.05).ConclusionNocturnal enuresis should not only be accepted as a urinary system disorder. Possible systemic causative factors have to be examined, especially in patients that are resistant to first-line therapy. Based on the results of our study, we deduce that one of the factors that plays a role in the pathogenesis of enuresis nocturna is a non-dipping blood pressure profile (the “non-dipping” phenomenon).

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Section: Discussionsupporting

confidence: 72%

Non-dipping phenomenon in children with monosymptomatic nocturnal enuresis

et al. 2013

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“…However, during recent years, factors outside of this axis have also been implicated. Abnormal renal sodium handling (1,32), aberrations in the urinary osmotic excretion (29), and excess renal prostaglandin production (23) have all been associated with the nocturnal polyuria of enuresis. A recent study in enuresis has even indicated differences in blood pressure profiles during nights with excess diuresis (27).…”

Section: Discussionmentioning

confidence: 99%

Excess diuresis and natriuresis during acute sleep deprivation in healthy adults

Kamperis

Hagstrøm

Radvanska

et al. 2010

American Journal of Physiology-Renal Physiology

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The transition from wakefulness to sleep is associated with a pronounced decline in diuresis, a necessary physiological process that allows uninterrupted sleep. The aim of this study was to assess the effect of acute sleep deprivation (SD) on urine output and renal water, sodium, and solute handling in healthy young volunteers. Twenty young adults (10 male) were recruited for two 24-h studies under standardized dietary conditions. During one of the two admissions, subjects were deprived of sleep. Urine output, electrolyte excretions, and osmolar excretions were calculated. Activated renin, angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic peptide were measured in plasma, whereas prostaglandin E(2) and melatonin were measured in urine. SD markedly increased the diuresis and led to excess renal sodium excretion. The effect was more pronounced in men who shared significantly higher diuresis levels during SD compared with women. Renal water handling and arginine vasopressin levels remained unaltered during SD, but the circadian rhythm of the hormones of the renin-angiotensin-aldosterone system was significantly affected. Urinary melatonin and prostaglandin E(2) excretion levels were comparable between SD and baseline night. Hemodynamic changes were characterized by the attenuation of nocturnal blood pressure dipping and an increase in creatinine clearance. Acute deprivation of sleep induces natriuresis and osmotic diuresis, leading to excess nocturnal urine production, especially in men. Hemodynamic changes during SD may, through renal and hormonal processes, be responsible for these observations. Sleep architecture disturbances should be considered in clinical settings with nocturnal polyuria such as enuresis in children and nocturia in adults.

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“…In approximately two-thirds of monosymptomatic PNE patients, the circadian rhythm of arginine vasopressin (AVP) is underdeveloped, causing excessive nighttime urine production [14,15]. In around one-third of patients, the bladder is unstable and contracts during sleep [16].…”

Section: Introductionmentioning

confidence: 99%