ABSTRACT
ADH is a hormone secreted by neurohypophysis that plays different roles based on the target organ. At the renal level, this peptide is capable of causing electrolyte-free water absorption, thus playing a key role in the hydro-electrolytic balance. There are pathologies and disorders that jeopardize this balance and, in this field, ADH receptor inhibitors such as Vaptans could play a key role. By inhibiting the activation pathway of vasopressin, they are potentially useful in euvolemic and hypervolemic hypotonic hyponatremia. However, clinical trials in heart failure have not given favourable results on clinical outcomes. Even in SIADH, despite their wide use, there is no agreement by experts on their use. Since vaptans inhibit the cAMP pathway in tubular cells, their use has been proposed to inhibit cystogenesis. A clinical trial has shown favourable effects on ADPKD progression. Because vaptans have been shown to be effective in models of renal cysts disorders other than ADPKD, their use has been proposed in diseases such as nephronophthisis and recessive autosomal polycystic disease. Other possible uses of vaptans could be in kidney transplantation and cardiorenal syndrome. Due to the activity of ADH in coagulation and haemostasis, ADH's activation pathway by Desmopressin Acetate could be a useful strategy to reduce the risk of bleeding in biopsies in patients with haemorrhagic risk.
Subject(s)
Antidiuretic Hormone Receptor Antagonists/therapeutic use , Kidney Diseases/drug therapy , Molecular Targeted Therapy , Neurophysins/agonists , Neurophysins/antagonists & inhibitors , Protein Precursors/agonists , Protein Precursors/antagonists & inhibitors , Receptors, Vasopressin/drug effects , Vasopressins/agonists , Vasopressins/antagonists & inhibitors , Water-Electrolyte Imbalance/drug therapy , Antidiuretic Hormone Receptor Antagonists/pharmacology , Cadaver , Cyclic AMP/physiology , Forecasting , Humans , Hyponatremia/drug therapy , Hyponatremia/physiopathology , Kidney Diseases/physiopathology , Kidney Diseases, Cystic/drug therapy , Kidney Transplantation , Kidney Tubules, Collecting/drug effects , Kidney Tubules, Collecting/physiology , Neurophysins/physiology , Polycystic Kidney, Autosomal Dominant/drug therapy , Polycystic Kidney, Autosomal Dominant/physiopathology , Protein Precursors/physiology , Receptors, Vasopressin/agonists , Second Messenger Systems/drug effects , Tissue Donors , Vasopressins/physiologyABSTRACT
Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family. Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after being successfully dry at night for at least 6 months). Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of the abnormalities mentioned above. Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine. This group (non-monosymptomatic nocturnal enuresis) requires a different clinical approach, with a focus on treating daytime bladder symptoms, which commonly involves pharmacotherapy with anticholinergic medications and urotherapy (including addressing bowel problems). This review discusses the current management of nocturnal enuresis using the terminologies recommended by the International Children's Continence Society.
