Circadian rhythm of water and solute excretion in nocturnal enuresis

Sevasti Karamaria, Lien Dossche, Vincent Delens, Eva Degraeuwe, Ann Raes, Reiner Mauel, Caroline Vande Walle, Karel Everaert, Johan Vande Walle

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Nocturnal polyuria (NP) due to a suppressed vasopressin circadian rhythm is a well-documented pathogenetic mechanism in enuresis, mainly studied in monosymptomatic enuresis. A substantial percentage of patients do not respond to desmopressin. This suggests that NP may not only be related to vasopressin, but that other kidney components play a role. Solute handling and osmotic excretion have been investigated in the past, especially in refractory patients. Nevertheless, data in treatment-naïve populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naïve patients with or without NP, with emphasis on circadian rhythms. Methods: Retrospective analysis of 403 treatment-naïve children 5–18 years with severe enuresis (> 8 nights/2 weeks). Circadian rhythms were evaluated by a 24-h urine collection in 8 timed portions (4 day, 4 nighttime) at in-home settings. Urine volume, osmolality, and creatinine were measured. Patients were subdivided into three groups according to nocturnal diuresis (ND) and Expected Bladder Capacity (EBCage) ratio: (a) < 100%, (b) 100–129%, (c) > 130%. Results: All groups maintained circadian rhythm for diuresis and diuresis rates. Patients with higher ND (100–129% and > 130% EBCage) had higher daytime volumes and less pronounced circadian rhythm. In the ND group > 130% EBCage, the ND rate was higher during the first night collection and osmotic excretion was significantly higher overnight. Conclusions: Overall 24-h fluid intake (reflected by 24-h diuresis) and nutritional intake (24-h osmotic excretion) might play a role in enuresis. Increased diuresis rate early in the night can be important in some patients, whereas the total night volume can be important in others. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary Information. [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)771-779
Number of pages9
JournalPediatric Nephrology
Issue number3
Publication statusPublished - Mar 2023

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© 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association.

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