Yaşar KANDUR, Oğuz SÖYLEMEZOĞLU, Kibriya FİDAN, Nesrin TAŞ

The effect of antidiuretic hormone on urine and serum electrolyte levelsin children with primary monosymptomatic nocturnal enuresis

Background/aim: The data concerning the effects of desmopressin on water/electrolyte disturbances of children with primary monosymptomatic nocturnal enuresis (PMNE) are limited. In the present study we aimed to evaluate the effect and tolerability of desmopressin on blood and urine electrolytes and osmolality in PMNE. Materials and methods: Thirty-five children with PMNE between the ages of 5 and 15 participated in the study. Patients collected urine during the daytime and acknowledged the night time fluid restriction before starting to use the desmopressin tablets. The medication was taken orally at least 1 h before bedtime. Blood and urine samples were collected before the introduction of the treatment (day 0) and on the third and seventh days of the administration of desmopressin to determine osmolality and electrolyte levels. Results: Thirty-five patients participated in the study. Twenty-one patients (60%) were male and 14 (40%) were female. The mean age was 9.6 ± 2.7 years. There were no significant changes in serum osmolality, urine osmolality, and serum sodium concentration. Mean urine calcium/creatinine ratio was 0.03 ± 0.01 mg/mg at the beginning, 0.06 ± 0.02 mg/mg on the third day, and 0.04 ± 0.01 mg/mg on the seventh day of the study. No significant changes were seen in urine calcium/creatinine ratio before and after treatment. Conclusion: Desmopressin appeared to be a well-tolerated drug and provided a safe and effective treatment for children who were following fluid intake restriction for PMNE.

PDF

___

1. Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010; 29: 213-240.
2. Jain S, Bhatt GC. Advances in the management of primary monosymptomatic nocturnal enuresis in Children Paediatr Int Child Health 2016; 36: 7-14.
3. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int 2006; 97: 1069-1073.
4. Hjalmas K, Arnold T, Bower W, Caione P, Chiozza LM, von Gontard A, Han SW, Husman DA, Kawauchi A, LAckgren G et al. Nocturnal enuresis: an international evidence based management strategy. J Urol 2004; 171: 2545-2561.
5. van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, Jennum P, Johnson T, Lose G, Mattiasson A et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 179-183.
6. Pace G, Aceto G, Cormio L, Traficante A, Tempesta A, Lospalluti ML, Selvaggi, FP, Penza R. Nocturnal enuresis can be caused by absorptive hypercalciuria. Scan J Urol Nephrol 1999; 33: 111-114.
7. Aikawa T, Kasahara T, Uchiyama M. The arginine vasopressin secretion profile of children with primary nocturnal enuresis. Eur Urol 1998; 33 (Suppl.): 41-44.
8. Medel R, Dieguez S, Brindo M, Ayuso S, Canepa C, Ruarte A, Podesta ML. Monosymptomatic primary enuresis: differences between patients or not responding to oral desmopressin.Br J Urol 1998; 81 (Suppl.): 46-49.
9. Rittig S, Knudsen UB, Nørgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol 1989; 256: 664- 671.
10. Tuncel A, Mavituna I, Nalcacioglu V, Tekdogan U, Uzun B, Atan A. Long-term follow-up of enuretic alarm treatment in enuresis nocturna. Scand J Urol Nephrol 2008; 42: 449-454.
11. Mattiasson A, Abrams P, Van Kerrebroeck P, Walter S, Weiss J. Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men. BJU Int 2002; 89: 855-862.
12. Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgül S, Vande Walle J, Yeung CK, Robson L. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Childrens Continence Society. J Urol 2010; 183: 441-447.
13. Rembratt A, Riis A, Nørgaard JP. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia. Neurourol Urodyn 2006; 25: 105-109.
14. Glazener CM, Evans JH. Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 2000; 2: CD002112.
15. Jarvelin MR, Vikevainen-Tervonen I, Morlanen I, Huttunen NP. Enuresis in seven-year-old children. Acta Pediatr Scand 1988; 77: 148-153.
16. Matthiesen TB, Rittig S, Nørgaard JP, Pedersen EB, Djurhuus JC. Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol 1996; 156: 1292-1299.
17. Bodo G, Gontero P, Casetta G, Alpa M, Brossa G, Russo R, Tizzani A. Circadian antidiuretic hormone variation in elderly men complaining of persistent nocturia after urinary flow obstruction removal. Scand J Urol Nephrol 1998; 32: 320-324.
18. Moon DG, Jin MH, Lee JG, Kim JJ, KimMG, Cha DR. Antidiuretic hormone in elderly male patients with severe nocturia: a circadian study. BJU Int 2004; 94: 571-575.
19. Graugaard-Jensen C, Rittig S, Djurhuus JC. Nocturia and circadian blood pressure profile in healthy elderly male volunteers. J Urol 2006; 176: 1034-1039.
20. Natsume O. A clinical investigation of nocturnal polyuria in patients with nocturia: a diurnal variation in arginine vasopressin secretion and its relevance to mean blood pressure. J Urol 2006; 176: 660-664.
21. Palm C, Cross P. V2-vasopressin receptor antagonists mechanism of effect and clinical implications in hyponatremia. Nephrol Dial Transplant 1999; 14: 2559-2562.
22. Osterberg O, Savic RM, Karlsson MO, Simonsson US, Nørgaard JP, Walle JV, Agersø H. Pharmacokinetics of desmopressin administrated as an oral lyophilisate dosage form in children with primary nocturnal enuresis and healthy adults. J Clin Pharmacol 2006; 46: 1204-1211.
23. Vande Walle JGJ, Bogaert GA, Mattsson S, Schurmans T, Hoebeke P, Deboe V, Norgaard JP; Desmopressin Oral Lyophilisate PD/PK Study Group. A new fast-melting oral formulation of desmopressin: a pharmacodynamic study in children with primary nocturnal enuresis. BJU Int 2006; 97: 603-609.
24. Rembratt A, Norgaard JP, Andersson KE. Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output, sleep and voiding patterns. BJU Int 2003; 91: 642- 646.
25. Chang YL, Lin AT, Chen KK. Short-term effects of desmopressin on water and electrolyte excretion in adults with nocturnal polyuria. J Urol 2007; 177: 2227-2229.
26. Kang DI, Kim HM, Oh SY, Yoon JH, Kim HM, Min KS. Short term effect and safety of antidiuretic hormone in the patients with nocturia. Int Neurourol J 2010; 14: 227-231.
27. Rushton HG, Belman AB, Zaontz M, Skoog SJ, Sihelnik S. Response to desmopressin as a function of urine osmolality in the treatment of monosymptomatic nocturnal enuresis : a double-blind prospective study. J Urol 1995; 154: 749-753.
28. Yuri VN, Kuznetsova A. Defect of osmoregulatory renal function ın nocturnal enuresis. Scand J Urol Nephrol 1999; 33: 40-44.
29. Ecelbarger CA, Kim GH, Knepper MA, Liu J, Tate M, Welling PA, Wade JB. Regulation of potassium channel Kir 1.1 (ROMK) abundance in the thick ascending limb of Henles loop. J Am Soc Nephrol 2001; 12: 10-18.