Department of Pediatric Nephrology, Children's Hospital Zagreb, Klaiceva 16, 10000, Zagreb, Croatia.
Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia.
Int Urol Nephrol. 2021 Aug;53(8):1529-1534. doi: 10.1007/s11255-021-02843-5. Epub 2021 Mar 27.
To determine the association between urine osmolality (Uosm) in patients with primary monosymptomatic enuresis (PMNE) and response to desmopressin (dDAVP) lyophilisate.
This was a prospective cohort study that included 419 children with enuresis seen in outpatient clinic between October 2017 and October 2019. Patient workup included symptom checklist, 48 h frequency/volume chart, kidney and bladder ultrasound, uroflow, urinalysis and culture, spot urine Ca/creatinine, and first-morning Uosm. Patients < 5 years, with secondary enuresis, or loss of follow-up were excluded. Oral dDAVP lyophilisate was recommended to all with PMNE and normal bladder capacity. After 1 month of therapy, initial success was assessed according to ICCS. Significant predictor variables for complete response were identified and analyzed using correlation coefficients and binary logistic regression.
There were 48 patients with PMNE who received dDAVP and were followed for treatment success. Partial and complete responses were achieved for 14 (29.2%) and 20 cases (41.7%), respectively. Older age and lower Uosm were found to be significantly in favor of complete response to dDAVP lyophilisate, P = 0.007 and 0.033, respectively. ROC analysis determined the Uosm of ≤ 814 mOsm/kg as a cut-off value for complete success (sensitivity 65% and specificity 75%, AUC = 68.2%). The odds ratio for complete success for selected cut-off value was 5.57 (95% CI 1.588-19.551, P = 0.007).
High pretreatment morning Uosm (> 814 mOsm/kg) might be suggestive of an alternative treatment to dDAVP lyophilisate in PMNE because of the higher risk of treatment failure.
确定原发性单症状遗尿症（PMNE）患者的尿渗透压（Uosm）与去氨加压素（dDAVP）冻干剂反应之间的关系。
这是一项前瞻性队列研究，纳入了 2017 年 10 月至 2019 年 10 月间在门诊就诊的 419 例遗尿症患儿。患者检查包括症状检查表、48 小时频率/体积图表、肾脏和膀胱超声、尿流率、尿液分析和培养、晨尿 Uosm、Ca/creatinine 比值。排除年龄<5 岁、继发性遗尿症或失访的患者。所有 PMNE 且膀胱容量正常的患者均推荐口服 dDAVP 冻干剂。治疗 1 个月后，根据 ICCS 评估初始疗效。使用相关系数和二项逻辑回归分析确定完全缓解的显著预测变量，并进行分析。
共有 48 例 PMNE 患者接受了 dDAVP 治疗，并随访治疗效果。14 例（29.2%）和 20 例（41.7%）患者分别获得部分和完全缓解。发现年龄较大和 Uosm 较低与完全缓解 dDAVP 冻干剂显著相关，P 值分别为 0.007 和 0.033。ROC 分析确定 Uosm 临界值为≤814 mOsm/kg 作为完全成功的截定点（灵敏度 65%，特异性 75%，AUC=68.2%）。选择截定点的完全成功的优势比为 5.57（95%CI 1.588-19.551，P=0.007）。
高治疗前清晨 Uosm（>814 mOsm/kg）可能提示 PMNE 患者替代 dDAVP 冻干剂治疗，因为治疗失败的风险较高。
