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The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology.
Eur J Pediatr. 2016 Jun; 175(6):747-54.EJ

Abstract

Nocturnal polyuria in monosymptomatic nocturnal enuresis (MNE) has so far mainly been attributed to a disturbed circadian rhythm of renal water handling. Low vasopressin levels overnight correlate with absent maximal concentrating activity, resulting in an increased nocturnal diuresis with low urinary osmolality. Therefore, treatment with desmopressin is a rational choice. Unfortunately, 20 to 60 % of children with monosymptomatic enuresis are desmopressin-resistant. There is increasing evidence that other disturbed circadian rhythms might play a role in nocturnal polyuria. This review focuses on renal aspects in the pathophysiology of nocturnal polyuria in MNE, with special emphasis on circadian rhythms. Articles related to renal circadian rhythms and enuresis were searched through the PubMed library with the goal of providing a concise review.

CONCLUSION

Nocturnal polyuria can only partially be explained by blunted circadian rhythm of vasopressin secretion. Other alterations in the intrinsic renal circadian clock system also seem to be involved, especially in desmopressin-resistant enuresis.

WHAT IS KNOWN

• Disturbance in the circadian rhythm of arginine vasopressin secretion is related to nocturnal polyuria in children with enuresis. • Desmopressin is recommended as a treatment for monosymptomatic nocturnal enuresis, working as a vasopressin analogue acting on V2 receptors in the collecting ducts of the kidney. What is New: • Other renal circadian rhythms might play a role in nocturnal polyuria, especially in desmopressin-resistant case.

Authors+Show Affiliations

Department of Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. lien.dossche@ugent.be.Department of Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.Department of Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27138767

Citation

Dossche, L, et al. "The Pathophysiology of Monosymptomatic Nocturnal Enuresis With Special Emphasis On the Circadian Rhythm of Renal Physiology." European Journal of Pediatrics, vol. 175, no. 6, 2016, pp. 747-54.
Dossche L, Walle JV, Van Herzeele C. The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology. Eur J Pediatr. 2016;175(6):747-54.
Dossche, L., Walle, J. V., & Van Herzeele, C. (2016). The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology. European Journal of Pediatrics, 175(6), 747-54. https://doi.org/10.1007/s00431-016-2729-3
Dossche L, Walle JV, Van Herzeele C. The Pathophysiology of Monosymptomatic Nocturnal Enuresis With Special Emphasis On the Circadian Rhythm of Renal Physiology. Eur J Pediatr. 2016;175(6):747-54. PubMed PMID: 27138767.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology. AU - Dossche,L, AU - Walle,J Vande, AU - Van Herzeele,C, Y1 - 2016/05/02/ PY - 2016/02/03/received PY - 2016/04/25/accepted PY - 2016/04/15/revised PY - 2016/5/4/entrez PY - 2016/5/4/pubmed PY - 2017/7/7/medline KW - Children KW - Circadian rhythm KW - Enuresis KW - Pathophysiology KW - Renal SP - 747 EP - 54 JF - European journal of pediatrics JO - Eur J Pediatr VL - 175 IS - 6 N2 - UNLABELLED: Nocturnal polyuria in monosymptomatic nocturnal enuresis (MNE) has so far mainly been attributed to a disturbed circadian rhythm of renal water handling. Low vasopressin levels overnight correlate with absent maximal concentrating activity, resulting in an increased nocturnal diuresis with low urinary osmolality. Therefore, treatment with desmopressin is a rational choice. Unfortunately, 20 to 60 % of children with monosymptomatic enuresis are desmopressin-resistant. There is increasing evidence that other disturbed circadian rhythms might play a role in nocturnal polyuria. This review focuses on renal aspects in the pathophysiology of nocturnal polyuria in MNE, with special emphasis on circadian rhythms. Articles related to renal circadian rhythms and enuresis were searched through the PubMed library with the goal of providing a concise review. CONCLUSION: Nocturnal polyuria can only partially be explained by blunted circadian rhythm of vasopressin secretion. Other alterations in the intrinsic renal circadian clock system also seem to be involved, especially in desmopressin-resistant enuresis. WHAT IS KNOWN: • Disturbance in the circadian rhythm of arginine vasopressin secretion is related to nocturnal polyuria in children with enuresis. • Desmopressin is recommended as a treatment for monosymptomatic nocturnal enuresis, working as a vasopressin analogue acting on V2 receptors in the collecting ducts of the kidney. What is New: • Other renal circadian rhythms might play a role in nocturnal polyuria, especially in desmopressin-resistant case. SN - 1432-1076 UR - https://www.unboundmedicine.com/medline/citation/27138767/The_pathophysiology_of_monosymptomatic_nocturnal_enuresis_with_special_emphasis_on_the_circadian_rhythm_of_renal_physiology_ L2 - https://dx.doi.org/10.1007/s00431-016-2729-3 DB - PRIME DP - Unbound Medicine ER -