Natochin Y V, Kuznetsova A A
J.M. Sechenov Institut of Evolutionary Physiology and Biochemistry, St. Petersburg, Russia.
Pediatr Nephrol. 2000 Jan;14(1):42-7. doi: 10.1007/s004670050011.
Sixty-two children with nocturnal enuresis (43 boys, 19 girls aged 6-15 years) were treated with either desmopressin (Adiuretin-SD) (n = 32) or sodium diclofenac (n = 30). Desmopressin was effective in 85% of children and diclofenac in 33%. In children with primary nocturnal enuresis, the glomerular filtration rate was normal, whereas diuresis and solute excretion during the night were increased. Compared with healthy children, the nightly excretion of sodium was elevated by 43.7% and magnesium by 58.4%. A high correlation was found between the free water reabsorption and solute clearance (P < 0.001) in children with nocturnal enuresis. Changes in kidney function in nocturnal enuresis appear to be due to a decrease in the water and ion reabsorption in the thick ascending limb of Henle's loop because of a changed regulation of ion transport in this part of the nephron. Administration of desmopressin or a decrease in prostaglandin production after diclofenac administration restores the ion and water transport in the kidney, which results in the disappearance of nocturnal enuresis. The results indicate a role of changes in regulation of ion transport in renal tubules in the pathogenesis of one of the forms of primary nocturnal enuresis.
62名患有夜间遗尿症的儿童（43名男孩，19名女孩，年龄在6至15岁之间）接受了去氨加压素（醋酸去氨加压素）（n = 32）或双氯芬酸钠（n = 30）治疗。去氨加压素对85%的儿童有效，双氯芬酸钠对33%的儿童有效。在原发性夜间遗尿症儿童中，肾小球滤过率正常，而夜间的尿量和溶质排泄增加。与健康儿童相比，夜间钠排泄量升高了43.7%，镁排泄量升高了58.4%。在夜间遗尿症儿童中，发现自由水重吸收与溶质清除率之间存在高度相关性（P < 0.001）。夜间遗尿症患者的肾功能变化似乎是由于亨利袢升支粗段水和离子重吸收减少，这是由于该肾单位部分离子转运调节发生改变所致。给予去氨加压素或双氯芬酸钠给药后前列腺素生成减少可恢复肾脏中的离子和水转运，从而导致夜间遗尿症消失。结果表明肾小管离子转运调节变化在原发性夜间遗尿症一种类型的发病机制中起作用。
