Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis.

The diurnal variation of plasma vasopressin (AVP), urinary excretion rate, urinary osmolality, and serum osmolality was studied twice in 15 patients with enuresis and in 11 age, weight, and sex matched nonenuretic normal subjects. A diurnal rhythm of AVP with constant levels during the day (8 AM-10 PM) and a highly significant increase during the night (10 PM-8 AM) was found in normal subjects. In contrast, enuretics showed a significantly less pronounced nocturnal increase in AVP with significantly lower nocturnal levels than normal subjects. Normal subjects showed a diurnal rhythm in urinary excretion rate reciprocal to urinary osmolality with a low and highly concentrated nocturnal urinary output. In enuretics, however, this normal diurnal rhythm was absent. In conclusion, an abnormal diurnal rhythm of AVP seems to be an important pathophysiological factor in enuresis, explaining the abnormally high nocturnal urinary volume and the low nocturnal urinary osmolality found in these patients.