ESPN 51th Annual Meeting

ESPN 2018


 
Decreased nocturnal sodium excretion in desmopressin responsive enuresis with nocturnal polyuria
RIK VAN HOOIMISSEN 1 LIEN DOSSCHE 1 REINER MAUEL SEVASTI KARAMARIA 1 CHARLOTTE VANHERZEELE 1 ERIK VAN LAECKE 1 Ann Raes 1 Johan Vande Walle 1

1- Ugent, Safepedrug
 
Introduction:

The anti-enuretic effect of desmopressin in monosymptomatic enuresis with nocturnal polyuria (MNE+NP) is to the antidiuretic effect related to its concentrating activity, and does fit with the abnormal circadian rhythm of vasopressin theory (Rittig).  Recent findings that pathogenesis is not only related to increased diuresis volume overnight, but non vasopressin related mechanisms such as solute handling,  GFR, sleep and several vaso-actives, put into question if the desmopressin response rate is only V2 directed. Recent findings have shown that desmopressin response coincides with amelioration of sleep and cognitive functioning. The question raises if this direct V2 antidiuretic effect, might have additional beneficial effect on circadian rhythm of other renal functions

Material and methods:

Secondary analysis of a prospective study in 28 MNE +NP patients >5/7 days wet, with clinical history according to the ICCS, bladder diary, Timed 24 hours urine sampling for osmol, creat, Na, Cl, K, creatinine, volume with 24 hours sleep registration (PLMS, arousability, arousal index, FUSP). Patients were tested prior to and 6 months after initiation of desmopressin monotherapy

Results:

 Results : Desmopressin therapy resulted in a significant antidiuretic effect, increased concentrating capacity and anti-enuretic effect. 24/28 had disrupted sleeppattern with a PLMS >5. During treatment mean PLMS decreased significantly from 11 to 6. De timed urine sampling showed a significant decrease in  solute, Na, K and CK excretion,  effect on UK/UNa+K-ratio and decreased creatinine clearance 

Conclusions:

 Long term desmopressin therapy for enuresis results not only in an anti-enuretic effect related to antidiuresis, but coincides with decreased renal sodium and osmotic excretion in the first 6 hours of the night, what coincides with decreased FUSP and amelioration of sleep characteristics. This observation suggests that pathopysiolgy and response to therapy are more complex than just waterhandling. We suggest that the decreased filling rate of the bladder leads to longer uninterrupted sleep  time before void (FUSP), what results in less restless legs and disturbed sleep, and thereby regain of normal circadian rhythm of renal glomerular and tubular