Which condition would you suspect in a patient with chronic enuresis beyond the normal age and chronic fatigue?

The association of chronic enuresis beyond the normal age alongside chronic fatigue points towards pediatric chronic kidney disease (CKD). Enuresis, or involuntary urination at an age when it is expected to have stopped, can occur due to underlying kidney issues that affect urine concentration and output. In the case of CKD, the kidneys lose their ability to function properly over time, leading to difficulties with fluid balance, electrolyte management, and waste removal, which can manifest as both urinary difficulties and systemic symptoms such as fatigue.

Chronic fatigue in this context can also arise from the accumulation of toxins in the body due to impaired kidney function, contributing to a general sense of malaise. It is essential to recognize these symptoms together, as they suggest not only a urinary problem but also a potential systemic condition affecting the patient's overall well-being.

In contrast to chronic kidney disease, conditions such as diabetes insipidus, hyperthyroidism, and obstructive sleep apnea do not typically present with this specific combination of symptoms in a pediatric patient. Diabetes insipidus would lead to significant polyuria but is less likely to cause enuresis and chronic fatigue as primary features. Hyperthyroidism can cause fatigue, but it would typically also present with weight loss, heat intolerance