Therapeutic Efficacy of Hydrochlorothiazide in Primary Monosymptomatic Nocturnal Enuresis in Boys With Idiopathic Hypercalciuria

Yousefichaijan, Parsa; Sharafkhah, Mojtaba; Cyrus, Ali; Rafeie, Mohammad

doi:10.5812/numonthly.29127

Cited by 7 publications

(6 citation statements)

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“…Some groups have found increased prevalence of hypercalciuria in enuretic children and some have not . The few therapeutic studies that have been carried out have been of low quality, and have failed to provide evidence that hypercalciuria in enuretic children needs to be addressed in order to make them dry . Hypercalciuria, if present, is probably an epiphenomenon related to nocturnal polyuria …”

Section: Urine Productionmentioning

confidence: 99%

Pathogenesis of enuresis: Towards a new understanding

Nevéus

2017

Int J of Urology

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Abbreviations & Acronyms ADHD = attention deficit hyperactivity disorder CNS = central nervous system LC = locus coeruleus PAG = periaqueductal gray area PMC = pontine micturition center Abstract: Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus.

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Section: Urine Productionmentioning

confidence: 99%

Pathogenesis of enuresis: Towards a new understanding

Nevéus

2017

Int J of Urology

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“…Yousefichaijan et al in a study on the therapeutic effect of HCT on PMNE only in males, compared the case (HCT and conservative treatment) and control (conservative treatment) groups. They concluded that HCT was an effective therapeutic option; hence, it can be prescribed in the treatment of PMNE (17). Jang et al in a study showed that the impact of HCT, which induced hypocalciuria in hypercalciuric rats, was associated with increased expression of transient receptor potential vanilloid 5 (TRPV5) protein; TRPV5 may also have a significant effect on the regulation of calcium excretion from the urinary system (22).…”

Section: Discussionmentioning

confidence: 99%

“…thiazide diuretics are used as drugs that are easy to use, have few complications, are inexpensive, widely available, and acceptable (17). Thiazides induce calcium reabsorption in distal tubules of kidney and ameliorate hypercalciuria (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Efficacy of Hydrochlorothiazide in the Primary Monosymptomatic Nocturnal Enuresis of Children

et al. 2017

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Background: Nocturnal enuresis is a symptom with probably multiple etiologic factors and a high prevalence. Conventional therapies is expensive and complicated, since the effect of calcium on voiding dysfunction was approved. Therefore, to the current study aimed at evaluating the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis (PMNE). Methods: The current study was conducted based on the interviews with patients. Morning urine test was evaluated in children with PMNE detection and specific gravity < 1010 enrolled to the study (110 children comprised of 57 cases and 53 controls). Children were divided into 2 groups; in the case group, hydrochlorothiazide (tablet 1 mg/kg and maximum 50 mg) was administered in the morning and the control group was only given necessary training about enuresis. For 3 times and with 1 month interval (based on a predetermined questionnaire) the frequency of nocturnal enuresis was checked. Data were transferred into SPSS program and the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis was investigated. Findings: There was a statistically significant difference regarding the frequency of nocturnal enuresis between the 2 groups (P = 0.0001). Also, both groups were matched by age (P = 899) and gender (P = 607). Conclusions: Hydrochlorothiazide can be used as an effective and safe therapeutic option for treatment of primary monosymptomatic nocturnal enuresis.

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“…(9). Some authors found idiopathic hypercalciuria (IH) to be more common in children with PMNE than in children without nocturnal enuresis and for this reason they assume that IH could be one of the contributing pathophysiologic factor to PMNE (10,11,12). Considering 24 h-variations in urine calcium excretion, the diagnosis of hypercalciuria is most accurately determined from the urine collected for 24 h. This is usually difficult to achieve in children who have nocturnal enuresis.…”

Section: Introductionmentioning

confidence: 99%

Calciuria in children with primary mono-symptomatic nocturnal enuresis

Mulic

Muminovic³

et al. 2018

Sanamed

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Introduction: The prevalence of idiopathic hypercalciuria (IH) in healthy pediatric population ranges from 3.0% to 7.0%. There is insufficient data about IH in children with mono-symptomatic enuresis. The aim of this study was to examine calcium excretion in urine (UCa) in patients with primary mono-symptomatic nocturnal enuresis (PMNE). Methods: In patients with PMNE, aged 5 to 17 years, IH was determined in 24-h urine and from second morning spot urine. The completeness of the 24-h urine collections was estimated via measuring 24h-urine creatinine excretion (UCr) of 0.1-0.2 mmol/kg/24h. Results: Sixty patients with PMNE, 32 males and 28 girls, median age of 9 years were enrolled in the study. Only 41.7% patients successfully completed 24 h urine collection. IH, defined as 24-h UCa > 0.1 mmol/kg body weight, was diagnosed in 12% of the patients, while when defined as UCa/UCr > 0.8 mmol/mmol in children 5-7 years and > 0.6 mmol/mmol in those > 7 years, IH was 8.3% and 6.7% from 24h-urine and spot urine, respectively. Conclusion: Children and adolescents with PMNE are in risk of hypercalciuria. Therefore, it is useful to examine 24 hours of urine calcium excretion in these patients.

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Therapeutic Efficacy of Hydrochlorothiazide in Primary Monosymptomatic Nocturnal Enuresis in Boys With Idiopathic Hypercalciuria

Cited by 7 publications

References 20 publications

Pathogenesis of enuresis: Towards a new understanding

Pathogenesis of enuresis: Towards a new understanding

Therapeutic Efficacy of Hydrochlorothiazide in the Primary Monosymptomatic Nocturnal Enuresis of Children

Calciuria in children with primary mono-symptomatic nocturnal enuresis

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