The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis.

PURPOSE: Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. We assessed the safety of desmopressin in children 18 years or younger with nocturnal enuresis with a focus on the relative safety of the oral compared with the intranasal formulation. MATERIALS AND METHODS: Published data (MEDLINE) from December 1972 to August 2006 and post-marketing safety data from December 1972 to June 2005 were analyzed. RESULTS: A total of 21 clinical trials on desmopressin use in children with nocturnal enuresis were identified. There were no reports of hyponatremia. A total of 21 publications were identified that included 48 case reports of hyponatremia in children with nocturnal enuresis. In all case reports patients were treated with intranasal desmopressin. Post-marketing safety data included 151 cases of hyponatremia in children with nocturnal enuresis, of whom 145 were treated with intranasal desmopressin and 6 were treated with the tablet formulation. Prodromal symptoms of hyponatremia were identified as headache, nausea and vomiting. CONCLUSIONS: Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops.

Haemolytic uraemic syndrome.

Diarrhoea-associated haemolytic uraemic syndrome develops in about 5 to 10% of children with haemorrhagic colitis due to Escherichia coli (E. coli) O157:H7 and is a common cause of acute renal failure in childhood. Endothelial cell damage, white blood cell activation and platelet-endothelial cell interactions are important in the pathogenesis. Meticulous supportive care, with attention to nutrition and fluid, and electrolyte balance, is important. Dialysis is necessary in many children. Public health follow-up is important to minimise the spread of E. coli O157:H7, which is transmitted by person-to-person, as well as through contaminated food products. 20-year follow-up studies report that 75% of children recover without any clinically significant long term sequelae. Chronic renal failure is reported in about 5% of children.

Evaluating the child with proteinuria.

Proteinuria is a common laboratory finding in children. It might represent a benign condition or herald the presence of a serious underlying renal disease or systemic disorder. Investigation to confirm a diagnosis or seek reassurance is important. This paper discusses the various causes of proteinuria, and those aspects of the history, physical examination, and the laboratory tests that will help determine the cause or reassure that a serious problem is not currently present.

Secondary nocturnal enuresis.

Secondary nocturnal enuresis accounts for about one quarter of patients with bed-wetting. Although a psychological cause is responsible in some children, various other causes are possible and should be considered. This article reviews the epidemiology, psychological and social impact, causes, investigation, management, and prognosis of secondary nocturnal enuresis.

Subcutaneous nodules in Henoch-Schönlein purpura.

A 6.5-year-old boy with active Henoch-Schönlein purpura developed subcutaneous nodules (SCN), a vasculitic manifestation previously unreported in children with this disease. The authors suggest that pressure played a role in the pathogenesis of the SCN.

Oedema in childhood.

Oedema is a common childhood problem with important public health implications. It is an abnormal accumulation of fluid in the interstitial space which might result from a decrease in intravascular oncotic pressure, an increase in intravascular hydrostatic pressure, an increase in capillary permeability or impaired lymphatic drainage. Renal sodium retention is an important factor in generalised oedema. This article reviews the pathophysiology and aetiology of oedema in children and suggests an approach to evaluation, diagnosis and management of the problem.

Enuresis treatment in the US.

A retrospective review of new patients assessed for incontinence at The Center for Kidney and Bladder Problems in Children, The Children's Hospital, Greenville, South Carolina, USA, was conducted to determine the causes of day and night wetting and the treatment outcomes. One hundred and twenty-seven new patients were assessed. Invasive, diagnostic studies were carried out to establish a diagnosis and determine a treatment protocol in only 28% of patients. Improvement was noted in 51% of patients.

Genitourinary surgery and Arthur Jacobs: father of urology in Glasgow.

Arthur Jacobs (1899-1974) was the father of urology in Glasgow. His extensive experience with genitourinary tuberculosis, ureterosigmoidostomy, and bladder augmentation were far ahead of his time. He became an expert in retropubic prostatectomy and was a pioneer in early imaging techniques.

Mycoplasma penetrans and other mycoplasmas in urine of human immunodeficiency virus-positive children.

Urine samples from children with human immunodeficiency virus (HIV) infection and healthy controls were examined for mycoplasmas by culture. Standard biochemical assays, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and PCR (16S and 16S-23S spacer rRNA region) were used for identification of isolates. Mycoplasmas were identified from 13 (87%) of 15 HIV-positive patients and 3 (20%) of 15 HIV-negative control patients. The frequency and type of mycoplasma varied with the severity of HIV infection. Mycoplasma penetrans, Mycoplasma pirum, Mycoplasma fermentans, and Mycoplasma genitalium were isolated from patients with severe immunodeficiency. Mycoplasma hominis and Ureaplasma urealyticum were isolated more frequently from children in the early stages of HIV infection and from HIV-negative patients. Mycoplasma penetrans was isolated from one (50%) of two patients in Centers for Disease Control and Prevention (CDC) group B and from five (55.5%) of nine pediatric patients with AIDS (CDC group C). This is the first report that indicates that "AIDS-associated" mycoplasmas are more common in HIV-infected children than in HIV-negative controls.

Cystic dysplasia of the testis associated with multicystic dysplasia of the kidney.

A child with cystic dysplasia of the testis (CDT) that presented as a solid mass by ultrasound imaging is reported. The child also had ipsilateral multicystic dysplasia of the kidney (MCDK). A search of the literature revealed that unilateral renal agenesis (URA) is commonly associated with CDT. It is possible that CDT, MCDK, and URA share a common pathogenesis. Cystic changes in the epididymis were found in the patient and might be more frequently associated with CDT than previously reported. CDT should be considered in the differential diagnosis of a solid testicular mass detected by ultrasound.