Nocturnal Enuresis in a Child with Unilateral Renal Agenesis

Case at a Glance

A 7-year-old boy with unilateral renal agenesis presents with persistent nocturnal enuresis occurring in 95% of nights, despite successful daytime toilet training.

Patient's Story

The patient is a 7-year-old male who experiences nightly bedwetting approximately 95% of the time. He demonstrates complete daytime continence but is unable to maintain urinary control overnight. The child does not wake spontaneously during the night to urinate and typically sleeps through episodes, resulting in complete saturation of bedding and clothing. Multiple behavioral interventions and toilet training methods have been attempted without success, necessitating the continued use of overnight protective undergarments.

Initial Assessment

The patient has a significant past medical history of unilateral renal agenesis (congenital absence of one kidney), discovered incidentally at age 4 during evaluation for other symptoms. At that time, he was hospitalized for 4 days due to severe constipation, ketosis, and hypoglycemia, which have since resolved with dietary modifications and polyethylene glycol therapy. Previous nephrology evaluation cleared him from a renal standpoint.

The Diagnostic Journey

The family is questioning whether the patient's solitary kidney status could be contributing to his persistent nocturnal enuresis. Given his history of renal agenesis and previous metabolic complications, there is concern about whether urological or nephrological factors might be involved versus this being a developmental variant of normal bladder maturation.

Final Diagnosis

Primary nocturnal enuresis in a child with unilateral renal agenesis. The bedwetting appears to be developmental rather than directly related to his solitary kidney status, as many children experience delayed nighttime bladder control as a normal variation in development.

Treatment Plan

Continued supportive care with protective undergarments during sleep. Consultation with pediatrician to discuss additional behavioral strategies and potential medical interventions if indicated. Consider reassessment by nephrology if symptoms worsen or new concerns arise, though current evidence suggests the enuresis is likely developmental rather than related to renal anatomy.

Outcome and Follow-up

Family education provided regarding the common nature of nocturual enuresis in school-age children and its typical resolution with time. Ongoing monitoring recommended with pediatric provider to assess for improvement and determine if further intervention is warranted.