title: Nocturnal polyuria is related to 24-hour diuresis and osmotic excretion in an enuresis population referred to a tertiary center.
abstract: OBJECTIVE
  Primary nocturnal enuresis is a heterogeneous disorder, causing a mismatch between overnight diuresis volume and functional bladder capacity. Despite increasing insights in pathogenesis, lack of efficacy of the available treatments is a major problem. We evaluated characteristics of bladder volume and diuresis rate in patients with nocturnal enuresis referred to a tertiary enuresis center.
  
  
  METHODS
  Noninvasive screening including maximal voided volume, 24-hour circadian rhythm of diuresis and osmotic excretion from 1,000 consecutive patients.
  
  
  RESULTS
  Of the patients referred as having monosymptomatic nocturnal enuresis 32% were subsequently classified as having nonmonosymptomatic nocturnal enuresis. Differences in bladder volume and nocturnal diuresis characteristics between the monosymptomatic nocturnal enuresis and nonmonosymptomatic nocturnal enuresis groups were minimal.
  
  
  CONCLUSIONS
  The most common observation is a nocturnal diuresis volume greater than maximal voided volume, which in both groups can be caused by nocturnal polyuria or small bladder volume for patient age. The most striking observation is that the positive correlation between nocturnal diuresis volume rate and nocturnal osmotic excretion and 24-hour fluid intake is significantly higher than with the inversed urinary osmolality overnight, which is not only unexpected based on the theory of the primary suppression of vasopressin levels overnight, but also points to a more important role for nutritional and fluid intake than accepted, if not in the primary pathogenesis, then at least in therapy resistance.
authors.affiliation: Department of Pediatric Nephrology, University Hospital Gent, Gent, Belgium. Johan.VandeWalle@ugent.be
authors.forename: J
authors.initials: J
authors.lastname: Vande Walle
authors.forename: C
authors.initials: C
authors.lastname: Vande Walle
authors.forename: P
authors.initials: P
authors.lastname: Van Sintjan
authors.forename: A
authors.initials: A
authors.lastname: De Guchtenaere
authors.forename: A
authors.initials: A
authors.lastname: Raes
authors.forename: R
authors.initials: R
authors.lastname: Donckerwolcke
authors.forename: E
authors.initials: E
authors.lastname: Van Laecke
authors.forename: R
authors.initials: R
authors.lastname: Mauel
authors.forename: J
authors.initials: J
authors.lastname: Dehoorne
authors.forename: E
authors.initials: E
authors.lastname: Van Hoyweghen
authors.forename: P
authors.initials: P
authors.lastname: Hoebeke
mesh_terms: D000293:Adolescent; D001530:Belgium; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D004231:Diuresis / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000150:complications / Q000503:physiopathology*; D009994:Osmolar Concentration; D011141:Polyuria / Q000150:complications / Q000503:physiopathology*; D011336:Probability; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013997:Time Factors; D014554:Urination / Q000502:physiology; D014882:Water-Electrolyte Balance