atrial-natriuretic-factor and Enuresis

Topics: Adult; Arginine Vasopressin; Atrial Natriuretic Factor; Child; Circadian Rhythm; Enuresis; Humans; Urinary Bladder Diseases; Urination Disorders

Desmopressin may be a useful treatment in some, but not all, patients with nocturnal enuresis. We have evaluated a relation between nocturnal urine output in patients with primary monosymptomatic nocturnal enuresis and the treatment response to synthetic vasopressin.. Adolescent or adult enuretics and normal subjects were enrolled in the study and admitted to hospital for a 24 hour investigation of the diurnal variation in urine output, plasma vasopressin (AVP) and plasma atrial natriuretic peptide (ANP). The enuretics were characterized prior to investigation as either 1-desamino-8-D-arginine vasopressin (DDAVP) responders or non-responders. During admission the fluid intake was restricted to 25 ml/kg per day.. Twenty-four patients (15-37 years) with primary monosymptomatic nocturnal enuresis and 9 normal subjects (24-31 years).. Circulating levels of AVP, ANP, plasma electrolytes and plasma osmolality were measured (1400, 2000, 2300, 0200, 0500 and 0800 hours) together with urine volume, urine osmolality and urine electrolytes during daytime and nighttime. Tubular reabsorptive capacity for water, osmoles and creatinine were assessed as well as urinary and fractional excretion rates of sodium and potassium.. Controls and DDAVP non-responders had a significant decrease in urine output at night concomitant with a significant plasma AVP amplitude in peak/nadir values although both groups lacked a significant nocturnal increase in AVP. In contrast, in DDAVP responders there was no circadian variation in urine output and thus a nocturnal polyuria together with no oscillation in plasma AVP. The DDAVP responding group had a nocturnal urine production significantly larger than the two other groups. However, the mean 24 hour AVP levels were similar in all groups. The excessive urine production at night in DDAVP responders was accompanied by nocturnal natriuresis due to an increased fractional excretion of sodium. In contrast, nocturnal antidiuresis in controls and DDAVP non-responding enuretics coincided with diminished sodium excretion. Average ANP levels were elevated in both enuretic groups compared to normals, whereas a circadian variation was detected only in the latter.. It is concluded that DDAVP responsiveness is linked to the nocturnal urine production and that no pathophysiological role can be ascribed to AVP or ANP in DDAVP refractory adolescent and adult enuretics. Moreover, it is suggested that an abnormal tubular handling of sodium may contribute to the nocturnal polyuria seen in DDAVP responders.

Topics: Adolescent; Adult; Analysis of Variance; Atrial Natriuretic Factor; Case-Control Studies; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Renal Agents; Sodium; Treatment Outcome; Urination

The circadian variation of plasma atrial natriuretic peptide (ANP) in relation to urinary excretion of sodium (UNa) and potassium (UK) as well as clearance of creatinine (Ccrea) was assessed in 15 juvenile patients with enuresis nocturna and compared with 11 age-, sex-, and weight-matched normal subjects. Normal juveniles showed a highly significant diurnal variation (p less than 0.001) of plasma ANP with diurnal peak levels at midnight (0000 hours) and minimum levels at 0400 hours. Enuretic patients showed a similar diurnal rhythmicity with normal levels during day and night. In normals both UNa and UK showed significant diurnal rhythmicity with a marked reduction from daytime to night-time. Although the total diurnal excretions of UNa and UK were similar to normals, patients with enuresis showed abnormal diurnal variation in both UNa (p less than 0.05) and UK (p less than 0.01). The abnormal circadian rhythm of UNa and UK in enuretics seemed to be caused by abnormal tubular handling as similar abnormalities were found in the fractional excretions and as the circadian variation of Ccrea was normal. Especially during the first hours of sleep (2200 hours to 0000 hours), the patients showed polyuria (230 +/- 138 ml vs 116 +/- 58 ml, p less than 0.01), natriuresis (20.9 +/- 16.3 mmol l-1 vs 10.7 +/- 6.8 mmol l-1, p less than 0.01), and kaliuresis (7.3 +/- 6.3 mmol l-1 vs 3.7 +/- 2.3 mmol l-1, p less than 0.05), despite normal levels of plasma ANP. In conclusion, the study describes the diurnal variation of plasma ANP in relation to urinary excretion of sodium and potassium in a juvenile normal population. Patients with nocturnal enuresis show abnormal diurnal rhythmicity in the urinary excretion of sodium and potassium that is not correlated to the plasma levels of ANP.

Topics: Adolescent; Atrial Natriuretic Factor; Child; Circadian Rhythm; Creatinine; Enuresis; Female; Humans; Male; Natriuresis; Osmolar Concentration; Potassium; Urine

In 8 adult patients with monosymptomatic nocturnal enuresis (age 18-44 years) we twice investigated the circadian rhythm of plasma vasopressin, plasma atrial natriuretic peptide, serum osmolality, serum electrolytes as well as urinary excretion in relation to urodynamic variables. Seven of the patients showed a lack of diurnal rhythmicity in plasma vasopressin at both diurnal studies with no night-time increase. The nocturnal urinary volumes exceeded the bladder capacities with an average of 155%. This was mainly caused by a large excretion of poorly concentrated urine during the first hours of sleep. Although a slight nocturnal peak in plasma atrial natriuretic peptide was found no clear pathophysiological role could be determined for this peptide. It is concluded that the previously established vasopressin production abnormality in juvenile enuresis seems to persist in adult enuretics.

Topics: Adolescent; Adult; Analysis of Variance; Atrial Natriuretic Factor; Body Water; Circadian Rhythm; Electrolytes; Enuresis; Female; Humans; Kidney Tubules; Male; Osmolar Concentration; Urination; Vasopressins