Enuresis subtypes based on nocturnal hypercalciuria: a multicenter study.

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TitoloEnuresis subtypes based on nocturnal hypercalciuria: a multicenter study.
Tipo pubblicazioneJournal Article
Year of Publication2003
AutoriAceto, G, Penza, R, Coccioli, MS, Palumbo, F, Cresta, L, Cimador, M, Chiozza, ML, Caione, P
JournalJ Urol
Volume170
Issue4 Pt 2
Pagination1670-3
Date Published2003 Oct
ISSN0022-5347
Parole chiaveAdolescent, Adrenocorticotropic Hormone, Calcium, Child, Circadian Rhythm, Creatinine, Deamino Arginine Vasopressin, Diagnosis, Differential, Electrolytes, Enuresis, Female, Humans, Male, Polyuria, Vasopressins
Astratto

PURPOSE: Desmopressin may not be effective for nocturnal enuresis associated with polyuria and hypercalciuria. Nighttime hypercalciuria in an enuretic population from 5 centers and its correlation with nighttime polyuria were verified. MATERIALS AND METHODS: A total of 450 enuretic patients (278 males, 172 females, mean age 9.7 years) were evaluated with 72-hour micturition charts, urinalysis, serum creatinine and osmolarity, diurnal and nocturnal electrolytes with fractional Na+ and K+ urinary excretion, and nocturnal (4 a.m.) plasma vasopressin. Creatinine electrolytes and osmolarity were measured in daytime (8 a.m. to 8 p.m.) and nighttime (8 p.m. to 8 a.m.) urine volumes. Patients were divided into group 1 with nocturnal polyuria and group 2 without nocturnal polyuria. Hypercalciuria was defined as urinary calcium-to-urinary creatinine ratio greater than 0.21. Statistic evaluation was performed using chi-square, Pearson correlation and ANOVA tests. RESULTS: Nighttime polyuria was demonstrated in 292 bedwetters (65% group 1). Nocturnal hypercalciuria was present in 179 of the 450 children (39.7%), including 125 in group 1 (42.8%) and 54 in group 2 (34.2%), which was statistically significant (chi-square p = 0.008, Pearson correlation test r = 0.157). Daytime calciuria was not statistically modified in either group (group 1 p = 0.054, group 2 p = 0.56). Adrenocorticotropic hormone (ADH) was normal in 18.5% and low in 81.5% of enuretics with nocturnal hypercalciuria. ADH levels and nocturnal hypercalciuria significantly correlated (p = 0.003, r = 0.148). Conversely, the group 2 patients had normal ADH levels. CONCLUSIONS: Nocturnal hypercalciuria has a pivotal role in nocturnal enuresis, as it is significantly associated with low ADH levels and nocturnal polyuria. A new classification of nocturnal enuresis subtypes based on nighttime calciuria levels is mandatory to address treatment properly.

DOI10.1097/01.ju.0000091221.55082.17
Alternate JournalJ. Urol.
Citation Key112
PubMed ID14501688

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