enuresis/ bedwetting

[Guest guest]

Hi all,

I remember there being a few posts on this list a while back about

enuresis in children, so thought this article would be of interest.

Liquorice anyone? other anti-inflammatories?

Increased Sodium, Prostaglandin Excretion Seen in Refractory

Nocturnal Enuresis

By Will Boggs, MD

NEW YORK (Reuters Health) Dec 26 - Nocturnal polyuria in children

with nocturnal enuresis refractory to desmopressin treatment is

accompanied by increased excretion of sodium, urea and prostaglandin

E2, according to a report in the December issue of the American

Journal of Physiology - Renal Physiology.

" Enuresis can be the result of different abnormalities, such as in

the bladder function and the circadian urine production, and when

choosing treatment the pathophysiology should always be taken into

account, " Dr. Kostas Kamperis from University of Aarhus, Denmark told

Reuters Health. " Different modalities are suitable for different

children. "

Dr. Kamperis and colleagues evaluated 46 children, 7 to 14 years of

age, with desmopressin-resistant nocturnal enuresis with and without

nocturnal polyuria, compared with 15 healthy children.

Compared with other patients, children with nocturnal polyuria

excreted approximately twice as much urine during the night, the team

reports, though all three groups showed circadian variations in urine

output peaking between 4 and 8 p.m. and reaching the lowest levels at

night.

Urine sodium excretion and sodium fractional excretion were

significantly higher during nighttime among polyuric children, the

researchers note, but not among controls and nonpolyuric children.

In addition, urinary PGE2 excretion was significantly higher at night

among polyurics than among controls and nonpolyurics, the report

indicates.

" This natriuresis found in polyurics does not seem to reflect

abnormalities in either hemodynamics or the circadian rhythm of

sodium-regulating hormones such as atrial natriuretic peptide,

aldosterone, angiotensin II, and renin but may be secondary to

augmented excretion of PGE2, " the researchers conclude.

" This excess PGE2 generation found in this subgroup of enuretics may

also be responsible for the failure of desmopressin to control their

polyuria. "

" Our findings suggest therapeutic implications, since agents that can

modulate the excretion of sodium do exist, " Dr. Kamperis said. " If

there is indeed a population of enuretics that share excess excretion

of sodium at night, then the rationale exists for treatment with such

agents, " for example, imipramine and nonsteroidal anti-inflammatory

drugs such as indomethacin.

Am J Physiol Renal Physiol 2006;291:F1232-F1240.