Night-time urination reduced by cutting salt in diet

The need to pee at night (nocturia) – which affects most people over the age of 60 – is related to the amount of salt in your diet, according to new research presented at the European Society of Urology congress in London.

Most people over the age of 60 (and a substantial minority under 60) wake up one or more times during the night to go to the bathroom¹. This is nightime peeing, or nocturia.  Although it seems a simple problem, the lack of sleep can lead to other problems such as stress, irritability or tiredness, and so can have a significant negative impact on quality of life. There are several possible causes of nocturia. Now a group of Japanese scientists have discovered that reducing the amount of salt in one’s diet can significantly reduce excessive peeing – both during the day and when asleep.

A group of researchers from Nagasaki University, led by Dr Matsuo Tomohiro, has studied salt intake in a group of 321 men and women who had a high salt intake and had problems sleeping – Japanese people tend to have a higher than average salt intake.  The patients were given guidance and support to reduce salt consumption. They were followed for 12 weeks, and salt consumption measured biochemically.

223 members of the group were able to reduce their salt intake from 10.7 gm per day to 8.0 gm/day. In this group, the average night-time frequency of urination dropped from 2.3 times/night to 1.4 times. In contrast, 98 subjects increased their average salt intake from 9.6 gm/night to 11.0 gm/night, and they found that the need to urinate increased from 2.3 times/night to 2.7 times/night. The researchers also found that daytime urination was reduced when salt in the diet was reduced.

This reduction in the need to go to the bathroom at night caused a marked improvement in the quality of life of the participants, as measured by the standard CLSS-QoL questionnaire.

Dr Tomohiro said

“This is the first study to measure how salt intake affects the frequency of going to the bathroom, so we need to confirm the work with larger studies. Nigh- time urination is a real problem for many people, especially as they get older. This work holds out the possibility that a simply dietary modification might significantly improve the quality of life for many people”.

Commenting, Dr Marcus Drake (Bristol, UK), Working Group Lead for the EAU Guidelines Office Initiative on Nocturia, said:

“This is an important aspect of how patients potentially can help themselves to reduce the impact of frequent urination. Research generally focusses on reducing the amount of water a patient drinks, and the salt intake is generally not considered. Here we have a useful study showing how we need to consider all influences to get the best chance of improving the symptom”.

Campamentos, excursiones o dormir fuera resulta imposible para los niños que mojan la cama

 La enuresis nocturna, pérdida de orina involuntaria durante el sueño, afecta a un gran número de niños entre 5 y 14 años.

Aunque el niño que moja la cama sufre las consecuencias durante todo el año, es en verano cuando niños y padres padecen el problema especialmente. Acudir a campamentos, colonias,  excursiones o dormir en casa de los amigos se hace  imposible para el 17,2%⁽¹⁾ de estos niños por la vergüenza que supone que se conozca su problema.

Los niños enuréticos suelen acabar teniendo problemas de retraimiento social, baja autoestima, bajo rendimiento escolar, ansiedad, inseguridad y malestar.

La enuresis va mucho más allá del mero hecho de mojar la cama, según los últimos datos presentados en el Congreso Europeo de Urología Pediátrica, el 87% de los niños que moja la cama muestra un sueño interrumpido. En este sentido, un tratamiento adecuado mejora no solo su problema de enuresis sino que además, mejora la calidad del sueño, la función psicológica, disminuyen los problemas de atención y mejora la calidad de vida de estos niños.

Cuando un niño de más de 5 años sigue mojando la cama, es el momento de que los padres recurran al pediatra o el urólogo infantil para solucionar el problema. Aunque la prevalencia de la enuresis disminuye  con la edad, los episodios enuréticos en la adolescencia y edad adulta aumentan en gravedad y frecuencia, por lo que el abordaje y tratamiento de este trastorno debe ser temprano.

La falta de información de los padres, una mal entendida vergüenza y el ser considerado un tema tabú por las propias familias, restan sensibilidad hacia el problema, impide el diagnóstico por parte del experto y el tratamiento ya sea conductual o farmacológico. Restar importancia considerando que se solucionará con la edad, tiene importantes consecuencias en la vida del niño y la familia.

La enuresis puede ser síntoma de patologías más graves en el niño como la diabetes, infecciones o malformaciones del aparato urinario, infecciones de orina, etc., el médico, pediatra o urólogo, es el único capacitado para  determinar la causa real del trastorno, y determinar el tratamiento a seguir.

A pesar de la alta prevalencia, sólo 2 de cada 10 niños con enuresis son valorados y tratados por el especialista. Las causas médicas de la enuresis son conocidas por los expertos y aun así el 60% de los menores  utiliza pañal cada noche y el otro 40% moja la cama durante el sueño. Si el especialista establece el diagnóstico exacto y establece el tratamiento adecuado, la mayoría de casos tiene solución, evitándose prolongar el problema hasta la edad adulta con implicaciones decisivas en la vida profesional y personal.

Un gran número de enuresis se produce por causas hereditarias, mientras que el otro 10% puede aparecer tras acontecimientos  extraordinarios en la vida del niño que provocan pérdidas nocturnas ocasionales.

La Sociedad Española de Pediatría Extrahospitalaria y de AP (SEPEAP) ha publicado recientemente la "Guía de manejo y diagnóstico terapéutico de la Enuresis Infantil" con las principales claves para el abordaje del problema.

Discovery helps mice beat urinary tract infections

Scientists at Washington University School of Medicine in St. Louis have found new clues to why some urinary tract infections recur persistently after multiple rounds of treatment. Their research, conducted in mice, suggests that the bacteria that cause urinary tract infections take advantage of a cellular waste disposal system that normally helps fight invaders. In a counterintuitive finding, they learned that when the disposal system was disabled, the mice cleared urinary tract infections much more quickly and thoroughly.

"This could be the beginning of a paradigm shift in how we think about the relationship between this waste disposal system, known as autophagy, and disease-causing organisms," says senior author Indira Mysorekar, PhD, assistant professor of obstetrics and gynecology and of pathology and immunology. "There may be other persistent pathogens that have found ways to exploit autophagy, and that information will be very useful for identifying new treatments."

The results will be published the week of June 18, 2012, in the early online edition of The Proceedings of the National Academy of the Sciences.

Urinary tract infections are very common, particularly in women. In the United States alone, annual treatment costs are estimated to run as high as $1.6 billion. Scientists believe 80 percent to 90 percent of these infections are caused by the bacterium Escherichia coli (E. coli).

Data from the new study and earlier results have led Mysorekar and her colleagues to speculate that E. coli that cause recurrent urinary tract infections may hide in garbage-bin-like compartments within the cells that line the urinary tract.

These compartments, found in nearly all cells, are called autophagosomes. They sweep up debris within the cell, including harmful bacteria and worn-out cell parts. Then, they merge with other compartments in the cell that are filled with enzymes that break down the contents of autophagosomes.

"We think, but can't yet prove, that the bacteria have found a way to block this final step, " Myosrekar says. "This would transform the autophagosome from a death trap into a safe haven where the bacteria can wait, hidden from the immune system, for their next chance to start an infection."

In the new research, Mysorekar teamed with colleagues at the School of Medicine who had developed mice in which both copies of an important autophagy gene, Atg16L1, were impaired. Co-author Herbert W. Virgin, MD, PhD, Edward Mallinckrodt Professor and head of the Department of Pathology and Immunology, and others created the mice to study Crohn's disease, a chronic bowel inflammation associated with mutations in Atg16L1.

Co-lead authors Caihong Wang, DVM, PhD, a staff scientist, and Jane Symington, an MD/PhD student in the Mysorekar group, infected the mice with E. coli. The researchers found that bacteria levels in the urinary tracts of the modified mice decreased much more rapidly after infection than they did in normal mice. Cells lining the urinary tract in mice with the mutated gene also had significantly fewer dormant reservoirs of E. coli than in normal mice.

Source: Washington University in St. Louis