• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.85-89
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• 2015

Background: We examined the usefulness of urine osmolality, as a predictive factor in the treatment of monosymptomatic nocturnal enuresis (NE) with combination therapy of imipramine and desmopressin. Methods: From May 2014 to April 2015, 59 monosymptomatic NE patients participated in this study. Early morning urine osmolality was measured at 1 week and 1 day before combination therapy of imipramine and desmopressin, and at 1 week and 2 weeks after therapy. The response to combination therapy was evaluated at 3 months after treatment. The mean period of combination therapy was $6.4{\pm}4.2weeks$. Therapeutic response was classified as complete (0-1 wet night/week), partial (over 50% reduction of night) and non-responders (less than 50% reduction of night). Results: The cumulative rate of the complete and partial responders was 76.3%. Among the 3 groups, the statistically lowest value of pre-treatment urine osmolality was observed in the complete responder group (p<0.001). Urine osmolality increased in all groups after treatment, however, statistically the greatest difference between pre and post-treatment urine osmolality was observed in the complete responder group (p=0.024). No serious side effects were observed. Conclusion: Early morning urine osmolality and change of urine osmolality between pre and post-treatment have predictive values in the response to combined imipramine and desmopressin for treatment of monosymptomatic NE.

• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.430-435
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• 2007

Even though we drink and excrete water without recognition, the amount and the composition of body fluid remain constant everyday. Maintenance of a normal osmolality is under the control of water balance which is regulated by vasopressin despite sodium concentration is the dominant determinant of plasma osmolality. The increased plasma osmolality (hypernatremia) can be normalized by the concentration of urine, which is the other way of gaining free water than drinking water, while the low plasma osmolality (hyponatremia) can be normalized by the dilution of urine which is the only regulated way of free water excretion. On the other hand, volume status depends on the control of sodium balance which is regulated mainly by renin-angiotensin-aldosterone system, through which volume depletion can be restored by enhancing sodium retention and concomitant water reabsorption. This review focuses on the urine concentration and dilution mechanism mediated by vasopressin and the associated disorders; diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion.

• Korean Journal of Veterinary Service
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• v.45 no.2
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• pp.139-143
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• 2022

A 10-year-old, spayed female miniature schnauzer was referred to the Veterinary Medical Teaching Hospital of Chungnam National University due to evaluation of sudden polyuria (PU) and, polydipsia (PD) (540 mL/kg/day) with severe anemia and weight loss. Blood examination results were normal except for severe anemia (hematocrit, [HCT]: 11.8%). Urinalysis revealed a urine specific gravity (USG) of 1.003, whereas urine sediment was not specific. Urine osmolality was 90 mOsm (reference range: 800~2500 mOsm), and plasma osmolality was 303 mOsm. No specific lesions were found using diagnostic imaging including radiography, ultrasonography and magnetic resonance imaging (MRI). The serum cortisol level was normal in cosyntropin stimulation test. Plasma arginine vasopressin (AVP) concentration was <0.4 pg/mL (reference range: 3.49~5.45 pg/mL). Blood transfusion was initiated in addition to an oral prescription of desmopressin acetate (DDAVP, 0.1 mg/head) thrice a day for one week. The patient was rechecked for clinical signs, urine osmolality, and USG; the clinical signs of PU/PD were resolved, urine osmolality increased to 1106 mOsm, and, USG increased to 1.021. Considering the improved clinical signs, and increased urine osmolality, and USG after DDAVP treatment, the dog was diagnosed with central diabetes insipidus. USG and urine osmolality increased to >1.030 and 2200 mOsm, respectively. Anemia also gradually improved and HCT increased to >37%. DDAVP was tapered to 0.1 mg/head twice a day and all clinical signs in the patient have completely resolved.

• The Journal of Korean Medicine
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• v.21 no.1
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• pp.99-102
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• 2000

Central diabetes insipidus(CDI) results from deficient vasopressin(antidiuretic hormone) secretion and causes polydipsia and polyuria. Its etiologic diagnosis is confirmed with an increase of urine osmolality by administering desmopressin(DDAVP) after water restriction. Because cm is caused by deficiency of vasopressin, up to now, desmopressin, a synthetic analog of vasopressin, has been the drug of choice in the treatment of CDI. However, under such treatment, CDI patients suffer from the continual administration of DDAVP throughout one's life and high cost of the treatment We administrated oriental herb medicine on a cm patient in a state of discontinuance of DDAVP. Prior to the study, brain sella MRI was scanned to exclude germinoma. In addition, urine analysis, serum and urinary osmolality, daily urinary volume, serum electrolyte levels were measured. Chungsimyunjatang was administered for 15 days, and urine analysis, urine osmolality, daily urinary volume, serum Na were measured several times again during the therapy, As a result, urinary frequency increased, serum Na slightly elevated, but specific gravity of urine, urinary osmolality severely decreased and daily urinary volume substantially increased. However, the frequency of DDAVP treatment was reduced from four times per day to once or twice a day with the continual administration of the Chungsimyunja-tang for two months after the discharge.

• Childhood Kidney Diseases
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• v.4 no.1
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• pp.6-10
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• 2000

Purpose: To evaluate whether the urinary creatinine concentration is a reliable reference value to standardize urinary solute excretion in a spot urine sample during the first week of life. Methods: Spontaneously voided urine specimens were obtained in 49 healthy full term neonates, and in 33 healthy older children with the median ages of $5.7{\pm}4.3$ years, two urine samples were available with an interval of 2 to 3 days. Urine creatinine concentration was determined by the Jaffe test(CoBAS, Integra, Roche, Swiss). Uurine osmolality was determined by the freezing point depression test(Multi-osmette, Precision, USA). Results: Mean urinary creatinine and osmolality values of the first urine samples were not significantly different with the second urine samples in each group. Mean urinary creatinine and osmolality values in neonates were significantly different from the older children of the each urine sample(P<0.01). In neonates, the mean of the urinary oreatinine/osmolality ratios was higher than that of the older children(P<0.01). The urinary creatinine and the creatinine/osmolality values of the first urine samples were closely correlated with those of the second samples in both two groups(P<0.001). Conclusion: The urinary creatinine concentration during the first day of life is relatively stable, even when corrected for urinary osmolality The urinary creatinine and the urinary creatinine/osmolality ratio, therefore, can be used to standardize the urinary excretion of solutes in the neonate.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.145-151
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• 2007

Hypertonicity (hypernatremia) of extracellular fluid causes water movement out of cells, while hypotonicity(hyponatremia) causes water movement into cells, resulting in cellular shrinkage or cellular swelling, respectively. In most part of the body, the osmolality of extracellular fluid is maintained within narrow range($285-295 mOsm/kgH_2O$) and some deviations from this range are not problematic in most tissue of the body except brain. On the other hand, the osmolality in the human renal medulla fluctuates between 50 and $1,200 mOsm/kgH_2O$ in the process of urine dilution and concentration. The adaptation of renal medullary cells to the wide fluctuations in extracellular tonicity is crucial for the cell survival. This review will summarize the mechanisms of urine concentration and the adaptation of renal medullary cells to the hyper tonicity, which is mediated by TonEBP transcription factor and its target gene products(UT-A1 urea transporter etc.).

• Clinical and Experimental Pediatrics
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• v.59 no.4
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• pp.202-204
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• 2016

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

• The Korean Journal of Physiology
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• v.9 no.1
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• pp.23-32
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• 1975

In order to study the dally metabolism of sodium chloride and of nitrogen, 24-hour urine samples were collected from 1,593 normal Korean females whose ages varied from 2 to 80 years old. The volume, the concentration of chloride and the osmolality of the urine, add the total nitrogen were determined, along with the resting pulse rate and the blood pressure. The daily urine volume was maintained at $1,000{\sim}1,300\;ml/m^2/day$ in all age groups while the chloride concentration and osmolality of the urine samples were approximately 200 mEq/liter and 600 milliosmoles, respectively, in most of age groups. Hence the daily urinary output of sodium chloride was estimated to be approximately $15g/m^2$/day in adult groups. On the other hand, the daily excretion of total nitrogen amouted to approximately $5{\sim}6g/m^2/day$. These findings indicated that the average Korean females live on low-protein and high-salt diets throughout their life. Despite a known correlation between the incidence of hypertension and the high salt intake, none of the subjects employed in this work showed any sign of hypertension.

• Journal of Physiology & Pathology in Korean Medicine
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• v.17 no.2
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• pp.423-427
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• 2003

The present study was aimed to investigate whether ethanol-extract of Allium wageki has an ameliorative effect on the renal function in high fructose-diet induced hypertensive rats .. The urine osmolality (Uosmol) was decreased in rats with high fructose-diet (60%) during the whole experiment period without change of the urine volume (UV). The urinary excretion of sodium (UNaV) and chloride (UCIV) were decrease significantly in rats with fructose-induced hypertensive rats, whereas urinary excretion of potassium (UKV) was Increased. The creatinine clearance (Ccr) and solute-free water reabsorption were also decreased by treatment of fructose-rich diet. Among these renal functional parameters, Ccr was partially restored by the administration of ethanol-extract of Allium wageki. The Uosmol was also partially restored by the administration ethanol-extract of Allium wageki at the end of the experimental period. Taken together, ethanol-extract of Allium wageki has the ameliorative effect on glomerular filtration rate in rats with high fructose-diet induced hypertension.

• Journal of the East Asian Society of Dietary Life
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• v.15 no.2
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• pp.165-170
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• 2005

The present study was aimed to investigate whether ethanol-extract of Nelumbo nucifera has an ameliorative effect on the renal function in high fructose-diet induced hypertensive rats. The urine osmolality (Uosmel) was decreased in rats with high fructose-diet ($60\%$) during the whole experiment period without change of the urine volume (UV). The urinary excretion of sodium and chloride were decrease significantly in rats with fructose induced hypertensive rats, wheras urinary excretion of potassium was increased. The creatinine clearance (CCr) and solute-free water reabsorption were also decreased by treatment of fructose rich diet. Among these renal functional parameters, CCr was partially restored by the administration of ethanol-extract of Nelumbo nucifera. The Uosmol was also partially restored by the administration ethanol-extract of Nelumbo nucifera at the end of the experimental period. Taken together, ethanol-extract of Nelumbo nucifera has the ameliorative effect on glomerular filtration rate in rats with high fructose-diet induced hypertension.