nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2012-16-3/2-16-24nefr-609Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESНОЧНОЙ ЭНУРЕЗ У ДЕТЕЙNOCTURNAL ENURESIS IN CHILDRENКузнецоваА. А.KuznetsovaA. A.

Кафедра факультетской педиатрии 

лаборатория физиологии почки и водно-солевого обмена 

194100, Санкт-Петербург, ул. Литовская, д. 2, Тел.: 8-906-256-43-41

pediatr-kuznetsova@yandex.ruСанкт-Петербургская государственная педиатрическая медицинская академия, Институт эволюционной физиологии и биохимии им. И.М. Сеченова РАНRussian Federation201210032012163/21624Copyright © Кузнецова А.А., 20122012Кузнецова А.А.Kuznetsova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/609

Представлены современные данные о распространенности этиологии и патогенезе ночного энуреза. Распространенность ночного энуреза достигает 10–15% у детей в возрасте от 5 до 15 лет [1–4]. В последние годы вновь возрос интерес исследователей разных специальностей к вопросам этиопатогенеза ночного энуреза, что способствовало разработке новых способов увеличения эффективности его лечения. Основными причинами ночного недержания мочи являются некоторые формы патологии центральной нервной системы и нарушение регуляции функции мочевого пузыря, ночная полиурия [3, 5, 6]. Получила распространение гипотеза, согласно которой ночной энурез обусловлен изменением циркадного ритма секреции аргинин-вазопрессина, что проявляется в снижении его секреции в ночные часы, в результате увеличения образования мочи в ночные часы, развитием ночной полиурии [6, 7]. Подтверждением этого предположения стали данные об эффективности применения синтетического аналога вазопрессина – десмопрессина, который вызывает увеличение реабсорбции воды в собирательных трубках почки [8]. Результаты исследований последних лет выявили важную роль изменения регуляции функции почки в патогенезе ночного энуреза. Это обусловлено двумя факторами, одним из них служит уменьшение секреции вазопрессина гипофизом, другим – усиление секреции аутакоидов в почке, где они выступают локальными антагонистами во взаимоотношениях с антидиуретическим гормоном и могут быть причиной увеличения диуреза ночью [9].

Modern data about prevalence, etiology and pathogenesis of nocturnal enuresis are presented. The nocturnal enuresis meets at children till 5 years in 15 % of cases. It is a heterogeneous disorder with a whole variety of etiologic factors (genetic, endocrinological, neurobiological), particularly a dysfunction of the lower urinary tract. This is polietiologic disease in which development various factors (genetic, endocrine, neurogenetic), being accompanied dysfunction of the bottom urinary ways can take part. Despite the prevalence of enuresis many questions regarding its pathophysiological mechanisms remain disputable. There are three pathogenetic mechanisms that have sufficient scientific support: nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds. Nocturnal polyuria is often explained by a nocturnal lack of the antidiuretic pituitary hormone vasopressin. At primary nocturnal enuresis the urine incontience is noted at night from the moment of the birth. At secondary nocturnal enuresis arises in 6 months after the birth. Primary night enuresis associates with a night polyuriya, increased renal sodium excretion, higher secretion of prostaglandins. Desmopressin markedly reduced nocturnal urine output in patients with enuresis, minimizing sodium, urea and overall solute excretion.

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The authors declare that there are no conflicts of interest present.