Circadian Variation of Angiotensin II and Aldosterone in Nocturnal Enuresis: Relationship to Arterial Blood Pressure and Urine Output
- 1 August 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 176 (2), 774-780
- https://doi.org/10.1016/s0022-5347(06)00594-5
Abstract
We investigated the circadian rhythm of solute excretion and regulating hormones as well as blood pressure in patients with monosymptomatic nocturnal enuresis. We included 15 patients with a mean age ± SE of 13.4 ± 0.9 years who had monosymptomatic nocturnal enuresis with at least 3 wet nights weekly and a control group of 10 healthy children with a similar age and sex distribution. During inpatient circadian studies urine was collected during 6 periods and blood was drawn at 7 time points during 24 hours. Heart rate and blood pressure was recorded with an ambulatory blood pressure monitor every 30 to 60 minutes. The total patient group excreted a significantly larger nocturnal urine volume than controls (p <0.01). Five patients had marked nocturnal polyuria (nocturnal urine volume greater than the mean in the control group +2 SD), whereas urine output in the remaining patients without polyuria were similar to controls. Nocturnal polyuria was caused mainly by increased nocturnal solute excretion, especially Na. Serum aldosterone and plasma angiotensin II showed a marked circadian rhythm in normal children with a nocturnal increase concomitant with a significant decrease in mean arterial blood pressure during sleep. In contrast, the group of patients with nocturnal polyuria showed a lack of circadian rhythm in all excretion variables as well as an attenuated rhythm in plasma angiotensin II and mean arterial blood pressure. Interestingly this group had normal circadian rhythms of the circadian rhythm markers plasma cortisol and heart rate. The study suggests that an abnormally large nocturnal excretion of Na caused by selectively attenuated circadian rhythms of Na regulating hormones might be an important pathogenic factor in monosymptomatic nocturnal enuresis.Keywords
This publication has 15 references indexed in Scilit:
- NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGYJournal of Urology, 2004
- Possible Role of Prostaglandins in Pathogenesis of Nocturnal Enuresis in ChildrenScandinavian Journal of Urology and Nephrology, 2000
- Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandinsUrology, 1998
- Persistent enuresis caused by nocturnal polyuria is a maturation defect of the nyctihemeral rhythm of diuresisBritish Journal of Urology, 1998
- The arginine-vasopressin secretion profile of children with primary nocturnal enuresis.European Urology, 1998
- Single Dose Imipramine Reduces Nocturnal Urine Output in Patients With Nocturnal Enuresis and Nocturnal PolyuriaJournal of Urology, 1997
- The Influence of Small Functional Bladder Capacity and and Other Predictors on the Response to Desmopressin in the Management of Monosymptomatic Nocturnal EnuresisJournal of Urology, 1996
- Diurnal variation of plasma atrial natriuretic peptide in normals and patients with enuresis nocturnaScandinavian Journal of Clinical and Laboratory Investigation, 1991
- Measurement of angiotensin II in human plasma: Technical modifications and practical experienceClinica Chimica Acta; International Journal of Clinical Chemistry, 1976
- RELATIVE NOCTURNAL POLYURIA AS A FACTOR IN ENURESISThe Lancet, 1952