6533b7d1fe1ef96bd125cd3a
RESEARCH PRODUCT
Enuresis Subtypes Based on Nocturnal Hypercalciuria: A Multicenter Study
Rosa PenzaLorenzo CrestaMaria Laura ChiozzaFabrizio PalumboMaria Susanna CoccioliPaolo CaioneMarcello CimadorGabriella Acetosubject
Malemedicine.medical_specialtyAdolescentendocrine system diseasesUrinalysisVasopressinsUrologymedia_common.quotation_subjectPopulationUrinary incontinenceUrologyUrinary incontinenceurologic and male genital diseasesUrinationDiagnosis DifferentialElectrolytesAdrenocorticotropic HormonePolyuriaEnuresisElectrolyteInternal medicineEnuresimedicineHumansEnuresis; Polyuria; Urinary incontinence; Vasopressin; Adolescent; Adrenocorticotropic Hormone; Calcium; Child; Circadian Rhythm; Creatinine; Deamino Arginine Vasopressin; Diagnosis Differential; Electrolytes; Enuresis; Female; Humans; Male; Polyuria; Vasopressins; UrologyDeamino Arginine VasopressinHypercalciuriaChildDesmopressineducationmedia_commoneducation.field_of_studymedicine.diagnostic_testPolyuriabusiness.industryEnuresismedicine.diseasefemale genital diseases and pregnancy complicationsCircadian RhythmEndocrinologyCreatinineCalciumFemalemedicine.symptombusinessVasopressinhormones hormone substitutes and hormone antagonistsHumanmedicine.drugdescription
Purpose: Desmopressin may not be effective for nocturnal enuresis associated with polyuria and hypercalciuria. Nighttime hypercalciuria in an enuretic population from 5 centers and its correlation with nighttime polyuria were verified. Materials and Methods: A total of 450 enuretic patients (278 males, 172 females, mean age 9.7 years) were evaluated with 72-hour micturition charts, urinalysis, serum creatinine and osmolarity, diurnal and nocturnal electrolytes with fractional Na+ and K+ urinary excretion, and nocturnal (4 a.m.) plasma vasopressin. Creatinine electrolytes and osmolarity were measured in daytime (8 a.m. to 8 p.m.) and nighttime (8 p.m. to 8 a.m.) urine volumes. Patients were divided into group 1 with nocturnal polyuria and group 2 without nocturnal polyuria. Hypercalciuria was defined as urinary calcium-to-urinary creatinine ratio greater than 0.21. Statistic evaluation was performed using chi-square, Pearson correlation and ANOVA tests. Results: Nighttime polyuria was demonstrated in 292 bedwetters (65% group 1). Nocturnal hypercalciuria was present in 179 of the 450 children (39.7%), including 125 in group 1 (42.8%) and 54 in group 2 (34.2%), which was statistically significant (chi-square p = 0.008, Pearson correlation test r = 0.157). Daytime calciuria was not statistically modified in either group (group 1 p = 0.054, group 2 p = 0.56). Adrenocorticotropic hormone (ADH) was normal in 18.5% and low in 81.5% of enuretics with nocturnal hypercalciuria. ADH levels and nocturnal hypercalciuria significantly correlated (p = 0.003, r = 0.148). Conversely, the group 2 patients had normal ADH levels. Conclusions: Nocturnal hypercalciuria has a pivotal role in nocturnal enuresis, as it is significantly associated with low ADH levels and nocturnal polyuria. A new classification of nocturnal enuresis subtypes based on nighttime calciuria levels is mandatory to address treatment properly.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2003-01-01 | Journal of Urology |