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Evaluation of urinary aquaporin-2 and plasma copeptin as biomarkers of effectiveness of desmopressin acetate for the treatment of monosymptomatic nocturnal enuresis

Hara T, Ohtomo Y, Endo A, Niijima S, Yasui M, Shimizu T

Commentary by Konstantinos Kamperis

Biomarkers predict desmopressin efficacy in enuresis. Could a simple test identify the responders?

Desmopressin the specific V2 receptor agonist is first line treatment for nocturnal enuresis. The agent is expected to control the nocturnal urine production in children with nocturnal polyuria. Until now no biomarkers to predict desmopressin efficacy have been identified. In this paper the authors prospectively measured urine concentration of aquaporin-2 and serum copeptin levels (as a surrogate marker for vasopressin) in 32 children (age 6-11) with monosymptomatic nocturnal enuresis.

All subjects were treated with desmopressin orally disintegrating tablet (120-240 mcg) and characterized as desmoressin responders and non-responders.

After 8 weeks' treatment the authors were able to demonstrate a significant correlation between day to night ratios of urinary aquaporin-2 and percentage of wet nights. Responders shared increased AQP2 levels following desmopressin treatment presumably reflecting differences in the renal concentrating mechanisms between responders and non-responders. Furthermore, plasma copeptin levels at baseline appeared lower in desmopressin responders.

The authors suggest urinary aquaporin-2 as a biomarker of desmopressin treatment efficacy, while plasma copeptin levels before treatment may be predictive of subsequent desmopressin response.

The identification of prognostic markers for desmopressin response may potentially change the management of children with enuresis as a simple test may help the clinicians identify the children that would benefit from such a treatment approach. However further studies are needed on the specificity and sensitivity before such a test can be implemented in clinical routine.

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

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Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.