Renal concentrating capacity test by desmopressin in children: intranasal or intravenous route?
Intranasal administration of desmopressin (dDAVP) is frequently used to test renal concentrating capacity in children. However, the bioavailability of intranasal dDAVP is about 10% and may be modified by nasal congestion. The study aimed to compare the efficacy of intranasal dDAVP with an equivalent dose of intravenous dDAVP for a renal concentrating capacity test in children. We studied 18 children aged 12.6 +/- 3.8 years weighing more than 20 kg in whom a dDAVP test was indicated as part of global renal function evaluation. Spray applicator (Minirin Spray) was used for intranasal administration (20-40 micrograms according to BW); the dose of intravenous dDAVP (Minirin IV) was reduced to 10% (2-4 micrograms according to BW). A randomized sequence was used for the first intranasal or intravenous dDAVP test; the second alternate test was repeated in the same children in a time interval ranging from 1 to 3 weeks. Osmolality of the urine (Uosm, mosm/kg) was determined before (T0), then 2 (T2) and 4 (T4) h after dDAVP administration. There was no significant difference in Uosm at T0 (intranasal = 480 +/- 212, intravenous = 443 +/- 168 mosm/kg), T2 (604 +/- 226 and 542 +/- 173 mosm/kg, respectively), and T4 (657 +/- 206 and 629 +/- 190 mosm/kg, respectively). There was an obvious correlation between intranasal and intravenous Uosm at T4 (r2 = 0.826; p = 0.001). Even if intravenous dDAVP is of theoretical interest, intranasal administration of dDAVP using a spray applicator can be considered as first-choice method for a renal concentrating capacity test in children weighing more than 20 kg.
Feber
J
J
Unité de Néphrologie Pédiatrique, Hôpital Edouard-Herriot, Lyon, France.
Cochat
P
P
Hadj-Aïssa
A
A
Dubourg
L
L
Wright
C
C
Pozet
N
N
D000281:Administration, Intranasal; D000293:Adolescent; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007671:Kidney Concentrating Ability / Q000502:physiology*; D007674:Kidney Diseases / Q000175:diagnosis*; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D013997:Time Factors
D003894:Deamino Arginine Vasopressin