Effect of DDAVP on nocturnal enuresis in a patient with nephrogenic diabetes insipidus
Susanne Jonat, René Santer, Reinhard Schneppenheim, Tobias Obser, Paul Eggert
Klinik für
Allgemeine Pädiatrie der CAU, Schwanenweg 20, D-24105 Kiel, Germany
Correspondence to: Dr Eggert. email: p.eggert{at}pediatrics.uni-kiel.de
Accepted 2 March 1999
The case of an 8 year old boy with both nocturnal enuresis and
nephrogenic diabetes insipidus is presented. Diagnosis of nephrogenic diabetes insipidus was based on a typical medical history, the characteristic result of a fluid restriction test, the lack of an
effect of 1-desamino-8-D-arginine (DDAVP) on both urine
osmolality and plasma coagulation factors and, finally, the detection
of a hemizygous missense mutation within the arginine vasopressin (AVP) receptor gene. Hydrochlorothiazide treatment and dietary measures
reduced the patient's urine volume to one third of its original
volume. However, this had no effect on enuresis. The daily intranasal
application of DDAVP did not further reduce urine output but
dramatically decreased the frequency of bed wetting. This observation
contradicts the common notion that the therapeutic effect of DDAVP in
nocturnal enuresis is the result of compensation for a nocturnal AVP
deficit. Rather, it points to a different mode of action of DDAVP in
patients with enuresis. It is hypothesised that central AVP receptors
are a target of DDAVP and that they might play an important role in the
pathogenesis of nocturnal enuresis.
Keywords: nocturnal enuresis; nephrogenic diabetes insipidus; 1-desamino-8-D-arginine effect
© 1999 by Archives of Disease in Childhood
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This article has been cited by other articles:
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