Water deprivation test in children: challenging but still necessary for the differential diagnosis of polyuria-polydipsia syndrome.

Abstract

The differential diagnosis within polyuria-polydipsia syndrome, especially in the pediatric population, remains challenging. Despite its limited accuracy, the water deprivation test (WDT) is the reference test in pediatrics. We retrospectively analyzed performed in 65 pediatric patients (mean age 8.2 years; 0-17.9). We evaluated the accuracy and safety of the WDT, investigated possible baseline variables that could predict outcomes, and reevaluated interruption and interpretation criteria. Among the 83 WTDs performed, 47 (56.6%) were conclusive (accuracy= 53%). The simplified 2 hours-WDT was inconclusive in 47.6% of the sample. A baseline urinary osmolality (uOsm) greater than 279 mOsm/kg excluded arginine vasopressin deficiency (AVP-D) and/or AVP resistance (AVP-R) in all patients (sensitivity= 100%; specificity= 74%; p < 0.01). A uOsm greater than 533 mOsm/kg at the time of WTD discontinuation also excluded the diagnosis of AVP disorders in all subjects (sensitivity= 100%; specificity= 100%; p< 0.01). Therefore, a baseline uOsm> 279 mOsm/kg and a peak uOsm> 533 mOsm/kg excluded AVP disorders. These new cut-offs can improve WDT accuracy and should be validated in prospective studies. No serious adverse effects (SAE) were observed. The lower limit of 3% weight loss was the criterion for early WDT interruption in nine conclusive tests. The demonstrated safety encourages us to use weight losses greater than 5% as stopping intervals and also tolerate a more extended test duration when necessary. In conclusion, WDT in children and adolescents is safe and still necessary until better diagnostic tools are proven helpful in pediatric patients with polyuria-polydipsia syndrome.