The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology

Eur J Pediatr. 2016 Jun;175(6):747-54. doi: 10.1007/s00431-016-2729-3. Epub 2016 May 2.


Nocturnal polyuria in monosymptomatic nocturnal enuresis (MNE) has so far mainly been attributed to a disturbed circadian rhythm of renal water handling. Low vasopressin levels overnight correlate with absent maximal concentrating activity, resulting in an increased nocturnal diuresis with low urinary osmolality. Therefore, treatment with desmopressin is a rational choice. Unfortunately, 20 to 60 % of children with monosymptomatic enuresis are desmopressin-resistant. There is increasing evidence that other disturbed circadian rhythms might play a role in nocturnal polyuria. This review focuses on renal aspects in the pathophysiology of nocturnal polyuria in MNE, with special emphasis on circadian rhythms. Articles related to renal circadian rhythms and enuresis were searched through the PubMed library with the goal of providing a concise review.

Conclusion: Nocturnal polyuria can only partially be explained by blunted circadian rhythm of vasopressin secretion. Other alterations in the intrinsic renal circadian clock system also seem to be involved, especially in desmopressin-resistant enuresis.

What is known: • Disturbance in the circadian rhythm of arginine vasopressin secretion is related to nocturnal polyuria in children with enuresis. • Desmopressin is recommended as a treatment for monosymptomatic nocturnal enuresis, working as a vasopressin analogue acting on V2 receptors in the collecting ducts of the kidney. What is New: • Other renal circadian rhythms might play a role in nocturnal polyuria, especially in desmopressin-resistant case.

Keywords: Children; Circadian rhythm; Enuresis; Pathophysiology; Renal.

Publication types

  • Review

MeSH terms

  • Antidiuretic Agents / therapeutic use
  • Arginine Vasopressin / metabolism*
  • Child
  • Circadian Rhythm / physiology*
  • Deamino Arginine Vasopressin / therapeutic use
  • Humans
  • Kidney / physiology*
  • Nocturnal Enuresis / complications
  • Nocturnal Enuresis / drug therapy
  • Nocturnal Enuresis / physiopathology*
  • Polyuria / complications
  • Urinary Bladder / physiopathology*
  • Urination / physiology


  • Antidiuretic Agents
  • Arginine Vasopressin
  • Deamino Arginine Vasopressin