ESPN 51th Annual Meeting

ESPN 2018


 
Evaluation of a standardized appraoch of desmopressin resistant polyuria in MNE
REINER MAUEL 1 VALERIE SCHAMP 1 ANN RAES 1 GREET PAUWELS 1 ANN-SOFIE CORNELIS 1 JOKE YSENBAERT 1 MIEKE BOUVRY 1 LIEN DOSSCHE 1 EVELIEN SNAUWAERT 1 ERIK VANLAECKE 1 JOHAN VANDE WALLE 2

1- UZGENT, UNIVERSITY GHENT
2- safepedrug Ugent
 
Introduction:

 Up to 30% of children with nocturnalk enuresis and associated nocturnal polyuria are therapy resistant, to desmopressin and alarmetherapy, even after exclusion of any obvious bladderdysfunction. The pathophysiologic reasons are complex, and in the recent handbook of Geary and Schaefer and algorythm was proposed for a rationalized therapeutic approach, based on the combination of 14 days diary of nocturnal diuresis and 24 H urinary concentration therapy. 

Material and methods:

patients were therapy resistant patients, treated for >6 months, and proven refractory to combination therapy of alarm,  desmopressin and urotherapy,

There where subtyped into 3 groups according to anti-enuretic effect, antidiuretic  and concentrating capacity effect.

group I (n= 17): Patients with deficient antidiuretic effect, and deficient concentrating capacity, received a progressive work up with 1) compliance training 2) desmopressin respônse test PK/PD characteristics, 3) pharmacodynamic test to evaluate a) time to response, b) max concentrating capacity c) duration of action. Therapy was titrated to this findings

group II (n = 18): patients with deficient antidiuretic effect but appropriate desmopressin concentration activity (800 mosmol/l), received a progressive work up with 1) dietary sodium and osmotic load restriction 2) furosemide in the morning 3) indomethacin 4) other ..

 

Results:

 Antidiuretic response at the end of the therapy was 14/17 in group I, and 14/18 in group II, demonstrating that the algorythm does work in clinical practice.

Response in group I was obtained after compliance actions in 4, increase of desmopressine to 360µg in 6, timing of the drug in 4.

in group II: diet had no  some influence on the nocturnal polyuria but not on the enuresis, Furosemide was beneficial in 8 patients, 3 patients from added NSAID4s and 3 from additional therapeutic options.

Conclusions:

 Desmopressin resistant nocturnal polyuria in MNE is a burden. A rationalised therapeutic approach based on pathophysiologic mechanisms and additional tests results in a up to 90% response rate, but in a very well defined subgroup, excluding any bladder dysfunction