Bouvry, Mieke

Cornelis, Ann Sophie

De Bruijn, Nathalie

Dossche, Lien

Raes, Ann

Vande Walle, Johan

English

Ghent University Academic Bibliography

Therapy-resistant enuresis in adolescents, when sporting in the eveningDOSSCHE  L.1,2,, BOUVRY M.1, CORNELIS A.S. 1, DEBRUYN N.1, RAES A.1,2, VANDE WALLE J.1, 21Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium2On behalf of the SAFEPEDRUG consortium, http://safepedrug.euAimMethodResultsMonosymptomatic nocturnal enuresis (MNE) is frequently related tonocturnal polyuria.Desmopressin (dDAVP), a synthetic vasopressin analogue, is a levelA, grade I treatment option in these children.In the past years we observed 6 adolescents (3 cyclers + 3footballers, 14-18 years) with MNE from sport schools, who haddDAVP-resistant nocturnal polyuria, especially on nights followingevenings with intensive physical training. This contrasted with ourinitial idea that following sport and dehydration, they should havelower diuresis-volumes overnight.To investigate pathophysiological mechanisms thatmight explain dDAVP therapy-resistance.24-hours urine collection with timed voidings wasobtained, on a day with and without evening sporttraining. At least 30 to 60 minutes before sleeping,two tablets of 200 µg dDAVP was given. The use ofsport drinks was avoided, but there was no absolutefluid restriction in the evening. However, fluid intakewas obsolete after dDAVP intake until the nextmorning.Diuresis-rate overnight was in 6 of 6 patients higher on the sporting than on the non-sporting evening, mainly in the first 6 hours ofthe night (U5-U6) (Fig.1). This was associated with lower urinary osmolality (Fig.2) and higher osmotic and sodium excretion (Fig.3).24-hours sodium and solute excretion was not different. However, on the sporting evening there was obvious a water-and sodium-retention during the evening urine collections.IntroductionCONTACT: lien.dossche@ugent.be,  johan.vandewalle@ugent.beDepartment of Paediatric Nephrology, Ghent University Hospital, Ghent, BelgiumACKNOWLEDGEMENTS: Supported by the Agency for Innovation by Science andTechnology in Flanders (IWT) through the SAFEPEDRUG project (IWT/SBO 130033).Conclusion: The observation suggests that during sport, the active water-and sodium-retention (secondary to the exercise) with associated vasodilatation and increase of vaso-active hormones, results in adaptive increase in body-fluid/bloodvolume. Once vasodilation regresses, a normalization of fluid/bloodvolume is induced in the first hours of the night, probably related to increased circulating blood volume. Since this is not only a water-driven but also solute diuresis, this patients will be more likely dDAVP-resistant.Fig.1: Correlation between urinary osmolality and diuresis volume aswell in the days without sport D4 andN(5-8) as days with sport(D4S, N5-8s).Fig.2: Osmotic excretion in the evening (during and after the sport) is significantly lower, reflecting avid solute (sodium retention) , what together with the water retention, is suggestive for functional hypovolemia induced compensatory retention.Especially during the first 2 night collections N5 and N6 have higher osmotic excretions, suggestive for compensatory excretion, post vasodillation.Fig.3: Fig 3 a, b, c  present the diuresis rate, osmotic excretion and urinary osmolality on non-sporting days in comparison with sporting days.The evening collection, during and after the sport demonstrates lower osmotic excretion and diuresis volume, with higher urinary osmolality reflecting soluteand water retention. This is suggestive for functional hypovolemia in relation to the vasodilation.  Subsequently, this retained solute and water are excretedduring the beginning of the night (N5 and N6). 

Therapy-resistant enuresis in adolescents, when sporting in the evening

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Therapy-resistant enuresis in adolescents, when sporting in the evening

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