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Vol. 283, Issue 5, F895-F903, November 2002

Low-calcium diet in hypercalciuric enuretic children restores AQP2 excretion and improves clinical symptoms

Giovanna Valenti¹, Antonia Laera¹, Sabine Gouraud¹, Giuseppe Pace^2,, Gabriella Aceto³, Rosa Penza³, Francesco P. Selvaggi², and Maria Svelto¹

Departments of ¹ General and Environmental Physiology, ² Emergency and Transplantation, and ³ Developmental Age Biomedicine, University of Bari, 70100 Bari, Italy

In this study, we analyzed the effect of a therapeutic intervention in 46 enuretic children, 26 (57%) of whom were hypercalciuric. All the patients (n = 46) were treated with DDAVP for 3-6 mo. The hypercalciuric patients (n = 26) received a low-calcium diet (~500 mg/day) for the same period. After the therapy, the bed-wetting episodes stopped in 80% of the 46 patients tested. In those patients having low-AVP levels before the therapy, circulating AVP concentration returned to normal (>4 pg/ml), and the hypercalciuria was resolved in the hypercalciuric patients (calcium/creatinine ratio <0.2). Urinary aquaporin-2 (AQP2) levels were semiquantified by densitometric scanning and reported as a ratio between the intensity of the signal in the day vs. the night urine samples (day/night AQP2 ratio). In the hypercalciuric patients, the day/night AQP2 ratio returned to values close to those found in the healthy children (from 1.19 ± 0.20 before to 0.69 ± 0.10 after the treatment, n = 26, P = 0.03). In contrast, in the normocalciuric children we saw no significant modulation of AQP2 excretion (from 1.07 ± 0.14 before to 0.99 ± 0.14 after the treatment, n = 20). This study clearly demonstrates that urinary calcium levels modulate AQP2 excretion and is likely to be useful for treatment of children with enuresis.

aquaporin; hypercalciuria; enuresis; calcium-sensing receptors; vasopressin

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Deceased April 15, 2001.

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