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Liu X, Xie Y, Tang J, Zhong J, Lan D. Hyponatremia in babies: a 11-year single-center study. Front Pediatr 2024; 12:1338404. [PMID: 38903768 PMCID: PMC11187253 DOI: 10.3389/fped.2024.1338404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Hyponatremia is one of the most prevalent water-electrolyte disturbances encountered in clinical practice in pediatrics and can arise from various conditions. However, there are limited reports on hyponatremia in hospitalized infants. The objective of this study was to provide an overview of the incidence, etiologies, and clinical characteristics of hyponatremia in hospitalized babies (from birth to 3 years old) at a tertiary hospital. Method Computer records of all hospitalized babies (from birth to 3 years old) with hyponatremia were extracted from the First Affiliated Hospital of Guangxi Medical University's clinical databases. Results 801 patients from 39,019 hospital admissions were found to have hyponatremia and the overall prevalence of this condition was 2.05% in babies. Patients with hyponatremia due to aldosterone signaling abnormalities, neurological disorders, and liver diseases exhibited more severe outcomes than those with other etiologies. Conclusions Various conditions can result in hyponatremia in hospitalized babies. Aldosterone signaling abnormalities were not that uncommon and it could lead to severe hyponatremia in babies.
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Affiliation(s)
| | | | | | | | - Dan Lan
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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2
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Goshima K, Tamura H, Hidaka Y, Furuie K, Kuraoka S. A case of secondary pseudohypoaldosteronism that presented as poor weight gain. Clin Case Rep 2024; 12:e8722. [PMID: 38562574 PMCID: PMC10982118 DOI: 10.1002/ccr3.8722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Key clinical message Pseudohypoaldosteronism (PHA) carries a good prognosis if treated early and appropriately, but some cases can have life-threatening events. We underscored the need to consider secondary PHA as one of the differential diagnoses of hyponatremia and hyperkalemia in infancy. Abstract Pseudohypoaldosteronism (PHA) type 1 has two classifications; the primary type, caused by genetic abnormalities that develop during neonatal and infancy periods, and the secondary type, caused by urinary tract malformation and urinary tract infection. Secondary PHA, if treated early and appropriately, has a good prognosis; however, some cases can present life-threatening events. Therefore, early diagnosis is crucial. We present a case of early infancy secondary PHA presented with marked hyponatremia and poor weight gain. The patient's growth and development improved with secondary PHA treatment. Here, were demonstrated the value of prompt action against infection and electrolyte imbalance and the importance of imaging for diagnosis, and underscore the need to consider secondary PHA as a differential diagnoses of hyponatremia and hyperkalemia in infancy. However further studies, including basic research, to elucidate the diseases pathology is warranted.
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Affiliation(s)
- Keisuke Goshima
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiroshi Tamura
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Yuko Hidaka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Keishiro Furuie
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
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3
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Kocaoglu C, Akturk S. Analysis of patients presenting with serum electrolyte imbalance in terms of the differential diagnosis of pseudohypoaldosteronism. North Clin Istanb 2023; 10:754-760. [PMID: 38328721 PMCID: PMC10846578 DOI: 10.14744/nci.2022.70105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to contribute to the differential diagnosis of transient pseudohypoaldosteronism (t-PHA). METHODS Twenty-nine infants, younger than 24 weeks, and with high aldosterone levels were included in the study. The patients were divided into two groups as t-PHA and other diagnoses group. Of 29 patients, 18 were in the t-PHA group and 11 were in other diagnoses group. RESULTS The means aldosterone, plasma renin activities (PRA), adrenocorticotropic hormone (ACTH), cortisol, and 17-hydroxyprogesterone (17-OHP) of those with t-PHA were 138±92.8 ng/dL, 8.39±10.57 ng/mL/h, 26.86±19.56 ng/L, 19.44±21.84 μg/dL, and 7.66±10.71 ng/mL, respectively. In other diagnoses group, the mean level of aldosterone, PRA, ACTH, cortisol, and 17-OHP levels was 100.9±70 ng/dL, 5.49±8.41 ng/mL/h, 408.28±491.9 ng/L, 19.99±14.43 μg/dL, and 11.99±12.21 ng/mL, respectively. In the t-PHA group, the number of patients with high PRA was eight (50%), while the number of patients with high levels was two (18.1%) in other diagnoses group. In the t-PHA group, although the average serum K levels were the same in both groups, serum aldosterone/K ratios were higher. CONCLUSION When an infant younger than 24 weeks, with urinary tract infection and/or urinary tract malformation has electrolyte abnormalities, pediatricians should primarily consider the diagnosis of t-PHA. Thus, many unnecessary investigations and inappropriate treatments can be avoided.
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Affiliation(s)
- Celebi Kocaoglu
- Department of Pediatric Intensive Care, University of Health Sciences, Konya City Hospital, Konya, Turkiye
| | - Seyma Akturk
- Department of Pediatrics, University of Health Sciences, Konya City Hospital, Konya, Turkiye
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4
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Liu X, Xie Y, Tang J, Zhong J, Zeng D, Lan D. Aldosterone defects in infants and young children with hyperkalemia: A single center retrospective study. Front Pediatr 2023; 11:1092388. [PMID: 36726778 PMCID: PMC9885047 DOI: 10.3389/fped.2023.1092388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Hyperkalemia is a rare but severe condition in young children and usually discovered as a result of hemolysis of the blood samples taken. However, patients with defects in either aldosterone biosynthesis or function can also present with hyperkalemia- as well hyponatremia-associated, and metabolic acidosis. It is a challenge to make an accurate diagnosis of these clinical conditions. We conducted this study to investigate the clinical and genetic features of aldosterone signaling defects associated hyperkalemia in young children. METHOD A retrospective review was conducted at the pediatric department of the First Affiliated Hospital of Guangxi Medical University from 2012 to 2022. RESULTS 47 patients with hyperkalemia were enrolled, of which 80.9% (n = 38) were diagnosed with primary hypoaldosteronism, including congenital adrenal hyperplasia due to 21-hydroxylase deficiency (n = 32), isolated hypoaldosteronism (n = 1) due to CYP11B2 gene mutation and Xp21 contiguous gene deletion syndrome (n = 1). Additionally, 4 patients were clinically-diagnosed with primary adrenal insufficiency. Nine patients were confirmed with aldosterone resistance, of which one child was diagnosed with pseudohypoaldosteronism (PHA) type 1 with a mutation in the NR3C2 gene and 3 children were identified with PHA type 2 due to novel mutations in either the CUL3 or KLHL3 genes. Five patients had PHA type 3 because of pathologies of either the urinary or intestinal tracts. CONCLUSIONS The etiologies of infants with hyperkalemia associated with aldosterone defects were mostly due to primary hypoaldosteronism. An elevated plasma aldosterone level may be a useful biomarker for the diagnosis an aldosterone functional defect in patients presented with hyperkalemia. However, a normal plasma aldosterone level does rule out an aldosterone defect in either its biosynthesis or function, especially in young infants. Molecular genetic analyses can greatly help to clarify the complexity of disorders and can be used to confirm the diagnosis.
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Affiliation(s)
- Xu Liu
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanshu Xie
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Tang
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingzi Zhong
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan Zeng
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan Lan
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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5
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Morisaki A, Naruse Y, Shibata Y, Mori M, Hiramoto R. Transient Pseudohypoaldosteronism Secondary to Group B Streptococcus Pyelonephritis. Cureus 2021; 13:e15071. [PMID: 34026387 PMCID: PMC8133509 DOI: 10.7759/cureus.15071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Secondary pseudohypoaldosteronism is a condition characterized by aldosterone resistance in renal tubules. It is highly associated with urinary tract infection and urinary tract malformations. Only a few cases of pseudohypoaldosteronism secondary to group B Streptococcus pyelonephritis have been reported to date. A four-month-old boy developed poor sucking and weight loss, and his laboratory test results revealed hyponatremia, hyperkalemia, renal dysfunction, high anion gap metabolic acidosis, pyuria, and hydronephrosis. Laboratory tests including urinalysis confirmed the diagnosis of pseudohypoaldosteronism secondary to group B Streptococcus. He was treated with intravenous normal saline and antimicrobial therapy. Electrolyte disorders were addressed and he was discharged on the 10th day of hospitalization without any sequelae. Voiding cystourethrography performed after discharge showed bilateral grade 5 vesicoureteral reflux and intrarenal reflux in the right kidney. Transient pseudohypoaldosteronism is an important consideration in the differential diagnosis in infants with hyponatremia and hyperkalemia. A thorough evaluation for urinary tract malformations should be performed, including early abdominal ultrasonography and systemic management.
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Affiliation(s)
- Atsuo Morisaki
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Yuki Naruse
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Yui Shibata
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Masato Mori
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Ryugo Hiramoto
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
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6
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A rare cause of salt-wasting in early infancy: Transient pseudohypoaldosteronism. Turk Arch Pediatr 2021; 56:75-77. [PMID: 34013235 DOI: 10.14744/turkpediatriars.2020.38159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
Three infants aged between 38 days and 43 days all presented with poor weight gain, hyponatremia, hyperkalemia, and were diagnosed as having urinary tract infections, which were accompanied by urinary tract malformations in our cases. Hydration and infection treatments were given. A few days after admission, hormonal studies revealed normal cortisol and 17-hydroxy progesterone levels and markedly high aldosterone levels, thus the patients were diagnosed as having transient pseudohypoaldosteronism. After the proper treatment was given, the transient pseudohypoaldosteronism resolved. In conclusion, when an infant with urinary tract infection or malformation has electrolyte abnormalities, pediatricians should consider the diagnosis of transient pseudohypoaldosteronism.
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7
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Tseng MH, Huang JL, Huang SM, Tsai JD, Wu TW, Fan WL, Ding JJ, Lin SH. Clinical features, genetic background, and outcome in infants with urinary tract infection and type IV renal tubular acidosis. Pediatr Res 2020; 87:1251-1255. [PMID: 31852011 DOI: 10.1038/s41390-019-0727-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Type IV renal tubular acidosis (RTA) is a severe complication of urinary tract infection (UTI) in infants. A detailed clinical and molecular analysis is still lacking. METHODS Infants with UTI who exhibited features of type IV RTA were prospectively enrolled. Clinical, laboratory, and image characteristics and sequencing of genes responsible for phenotype were determined with follow-up. RESULTS The study cohort included 12 infants (9 males, age 1-8 months). All exhibited typical type IV RTA such as hyperkalemia with low transtubular potassium gradient, hyperchloremic metabolic acidosis with positive urine anion gap, hypovolemic hyponatremia with renal salt wasting, and high plasma renin and aldosterone levels. Seven had hyperkalemia-related arrhythmia and two of them developed life-threatening ventricular tachycardia. With prompt therapy, all clinical and biochemical abnormalities resolved within 1 week. Five had normal urinary tract anatomy, and three of them carried genetic variants on NR3C2. Three variants, c.1645T>G (S549A), c.538G>A (V180I), and c.1-2C>G, on NR3C2 were identified in four patients. During follow-up, none of them had recurrent type IV RTA, but four developed renal scaring. CONCLUSIONS Genetic mutation on NR3C2 may contribute to the development of type IV RTA as a complication of UTI in infants without identifiable risk factors, such as urinary tract anomalies.
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Affiliation(s)
- Min-Hua Tseng
- Division of Pediatric Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Huang
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Jeng-Daw Tsai
- Division of Nephrology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Wei Wu
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Wen-Lang Fan
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jhao-Jhuang Ding
- Division of Pediatric Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics. Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology. Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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8
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An infant with hyponatremia, hyperkalemia, and metabolic acidosis associated with urinary tract infection: Answers. Pediatr Nephrol 2019; 34:1739-1741. [PMID: 31053900 DOI: 10.1007/s00467-019-04254-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
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9
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Sethi SK, Wazir S, Bansal S, Khokhar S, Wadhwani N, Raina R. Secondary Pseudohypoaldosteronism Masquerading Congenital Adrenal Hyperplasia in a Neonate. Kidney Int Rep 2018; 3:752-754. [PMID: 29854986 PMCID: PMC5976876 DOI: 10.1016/j.ekir.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Sanjay Wazir
- Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India
| | - Shyam Bansal
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | | | - Nikita Wadhwani
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
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10
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Autosomal dominant pseudohypoaldosteronism type 1 in an infant with salt wasting crisis associated with urinary tract infection and obstructive uropathy. Case Rep Endocrinol 2013; 2013:524647. [PMID: 24455331 PMCID: PMC3880733 DOI: 10.1155/2013/524647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/04/2013] [Indexed: 11/17/2022] Open
Abstract
Type 1 pseudohypoaldosteronism (PHA1) is a salt wasting syndrome caused by renal resistance to aldosterone. Primary renal PHA1 or autosomal dominant PHA1 is caused by mutations in mineralocorticoids receptor gene (NR3C2), while secondary PHA1 is frequently associated with urinary tract infection (UTI) and/or urinary tract malformations (UTM). We report a 14-day-old male infant presenting with severe hyperkalemia, hyponatremic dehydration, metabolic acidosis, and markedly elevated serum aldosterone level, initially thought to have secondary PHA1 due to the associated UTI and posterior urethral valves. His serum aldosterone remained elevated at 5 months of age, despite resolution of salt wasting symptoms. Chromosomal microarray analysis revealed a deletion of exons 3-5 in NR3C2 in the patient and his asymptomatic mother who also had elevated serum aldosterone level, confirming that he had primary or autosomal dominant PHA1. Our case raises the possibility that some patients with secondary PHA1 attributed to UTI and/or UTM may instead have primary autosomal dominant PHA1, for which genetic testing should be considered to identify the cause, determine future recurrence risk, and possibly prevent the life-threatening salt wasting in a subsequent family member. Future clinical research is needed to investigate the potential overlapping between secondary PHA1 and primary autosomal dominant PHA1.
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11
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Park SJ, Oh YS, Choi MJ, Shin JI, Kim KH. Hyponatremia may reflect severe inflammation in children with febrile urinary tract infection. Pediatr Nephrol 2012; 27:2261-7. [PMID: 22847386 DOI: 10.1007/s00467-012-2267-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 06/30/2012] [Accepted: 07/02/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte abnormality in clinical practice, but little is known about the association between febrile urinary tract infection (UTI) and hyponatremia or its significance to clinical outcomes. METHODS Data from 140 children with febrile UTI between 2000 and 2010 were retrospectively analyzed. Laboratory examinations [white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum sodium concentration], renal ultrasonography, (99m)Technetium-dimercaptosuccinic acid (DMSA) scintigraphy, and voiding cystourethrogram were performed. Culture growing >50,000 colonies of one single bacterial species on a urine sample obtained by catheter or >100,000 colonies on two clean-catch samples was required to establish diagnosis of UTI. RESULTS In children with renal cortical defects diagnosed after DMSA scintigraphy (group 1), duration of fever was significantly longer (P = 0.038) and WBC (P = 0.047) and CRP (P < 0.0001) levels significantly higher than in those without renal cortical defects (group 2). However, serum sodium levels were significantly lower in group 1 than group 2 (135.9 ± 2.4 vs 137.4 ± 2.7 mEq/L, P = 0.007). Hyponatremia (serum sodium ≤ 135 mEq/L) was also more frequent in group 1 than in group 2 (74.1 % vs 45.3 %, P = 0.012). Serum sodium concentration was negatively correlated with WBC count (r = -0.156, P = 0.011) and CRP levels (r = -0.160, P= 0.028). CONCLUSIONS Our study indicates that hyponatremia may be a substantial inflammatory marker and is significantly and independently associated with the degree of inflammation in children with febrile UTI.
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Affiliation(s)
- Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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12
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Zennaro MC, Hubert EL, Fernandes-Rosa FL. Aldosterone resistance: structural and functional considerations and new perspectives. Mol Cell Endocrinol 2012; 350:206-15. [PMID: 21664233 DOI: 10.1016/j.mce.2011.04.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/20/2011] [Accepted: 04/24/2011] [Indexed: 11/30/2022]
Abstract
Aldosterone plays an essential role in the maintenance of fluid and electrolyte homeostasis in the distal nephron. Loss-of-function mutations in two key components of the aldosterone response, the mineralocorticoid receptor and the epithelial sodium channel ENaC, lead to type 1 pseudohypoaldosteronism (PHA1), a rare genetic disease of aldosterone resistance characterized by salt wasting, dehydration, failure to thrive, hyperkalemia and metabolic acidosis. This review describes the clinical, biological and genetic characteristics of the different forms of PHA1 and highlights recent advances in the understanding of the pathogenesis of the disease. We will also discuss genotype-phenotype correlations and new clinical and genetic entities that may prove relevant for patient's care in neonates with renal salt losing syndromes and/or failure to thrive.
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Electrolyte disturbances in acute pyelonephritis. Pediatr Nephrol 2012; 27:429-33. [PMID: 21983846 DOI: 10.1007/s00467-011-2020-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/03/2011] [Accepted: 08/08/2011] [Indexed: 10/17/2022]
Abstract
The aim of this study was to determine whether renal unresponsiveness to aldosterone associated with hyperkalemia is present in infants with acute pyelonephritis in the absence of significant urinary tract anomalies and to describe the clinical characteristics of patients presenting an inadequate renal response to hyperkalemia. The patient cohort comprised 113 infants with acute pyelonephritis (APN), based on the criteria of a temperature >38°C and significant bacteriuria. Serum and urine electrolytes, creatinine, osmolality, and renal tubular function tests were performed at diagnosis. The findings were compared to those present in 75 children who had fever without significant bacteriuria. Hyperkalemia (>5.5 mmol/L) was observed in infants with an APN diagnosis, who exhibited a lower transtubular potassium concentration gradient (TTKG) and a higher fractional sodium excretion. We defined inadequate renal response to hyperkalemia as the combination of hyperkalemia and TTKG below the normal range established for the age of the subject. Infants presenting an inadequate response to hyperkalemia were younger and associated more frequently with an APN diagnosis. This alteration could be explained by the renal interstitial inflammation present in acute pyelonephritis and the immaturity of the renal tubular responsiveness to aldosterone due to infancy in the absence of urinary tract infection or obstruction.
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14
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Delhikumar CG, Narayanan P, Mahadevan S. Pseudohypoaldosteronism masquerading as congenital adrenal hyperplasia. Indian J Pediatr 2012; 79:115-6. [PMID: 21638072 DOI: 10.1007/s12098-011-0490-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
A 15-day- old male infant presented with features suggestive of congenital adrenal hyperplasia (CAH). But on detailed investigation, he had normal 17-OH Progesterone and high aldosterone levels. Infant also had right sided hydronephrosis and associated urinary tract infection. Hence, a diagnosis of secondary pseudohypoaldosteronism was made. There was good response to sodium chloride supplementation and he was thriving well on follow up. While evaluating any infant with suspected CAH, one should consider secondary pseudohypoaldosteronism, especially when risk factors like urinary tract obstruction or UTI coexists.
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Affiliation(s)
- C G Delhikumar
- Department of Pediatrics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India
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15
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Ağladıoğlu SY, Aycan Z, Peltek Kendirci HN, Erkek N, Baş VN. Does pseudohypoaldosteronism mask the diagnosis of congenital adrenal hyperplasia? J Clin Res Pediatr Endocrinol 2011; 3:219-21. [PMID: 22155467 PMCID: PMC3245498 DOI: 10.4274/jcrpe.369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hyponatremia and hyperpotassemia occurring in the first few weeks of life primarily indicate aldosterone deficiency due to salt-losing congenital adrenal hyperplasia (SL-CAH), while mineralocorticoid deficiency and insensitivity are the main causes of hyponatremia and hyperpotassemia in older infants. Some patients who present with vomiting and poor sucking, who have hyponatremia and hyperpotassemia and are initially diagnosed as CAH, during follow-up, are found to suffer from pseudohypoaldosteronism (PHA). This situation has been reported several times before. The cases described here represent the opposite situation: they presented with hyponatremia and hyperpotassemia, thus PHA was considered as aldosterone levels were very high, but subsequent investigation and genetic analysis led to the diagnosis of SL-CAH.
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Affiliation(s)
- Sebahat Yılmaz Ağladıoğlu
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey.
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
| | - Havva Nur Peltek Kendirci
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
| | - Nilgün Erkek
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatrics, Ankara, Turkey
| | - Veysel Nijat Baş
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
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16
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Transient type 1 pseudo-hypoaldosteronism: report on an eight-patient series and literature review. Pediatr Nephrol 2009; 24:2167-75. [PMID: 19714368 DOI: 10.1007/s00467-009-1285-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/05/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
Eight boys aged 2-12 weeks with urinary tract malformations (UTMs) exhibited features of transient type 1 pseudo-hypoaldosteronism (TPHA1) in the course of urinary tract infection (UTI). Hyponatremia (120.9+/-5.8 mmol/l), hyperkalemia (6.9+/-0.9 mmol/l), metabolic acidosis (plasma bicarbonate 11+/-1.4 mmol/l), and a rise in serum creatinine levels (145+/-101 micromol/l) were associated with high urinary sodium (Na) and low potassium (K) excretion. Tubular resistance to aldosterone was indicated by high plasma aldosterone concentrations (170.4+/-100.5 ng/dl), high levels of the plasma aldosterone to potassium ratio (25.2+/-15.6), and diminished urinary K/Na values (0.31+/-0.19). With appropriate therapy, serum electrolytes, creatinine, and acid-base balance normalized within 2 weeks. A Medline search revealed another 85 cases of TPHA1 reported to date. All of the 93 patients were less than 7 months of age and 90% were less than 3 months of age, 90.3% suffered from UTM, with associated UTI in 89% of them, 11% had UTMin the absence of UTI, and 9.7% showed isolated UTI. These findings indicate that early infancy is the main contributing factor for TPHA1 to occur and that UTI and UTMare additional factors, with at least one being required for its development.
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Fujinaga S, Ohtomo Y, Someya T, Shimizu T, Yamashiro Y. Transient pseudohypoaldosteronism complicating acute renal failure in an infant with vesico-ureteral reflux and pyelonephritis. Pediatr Int 2009; 51:744-6. [PMID: 19799743 DOI: 10.1111/j.1442-200x.2009.02900.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan.
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Peddle M, Joubert G, Lim R. Case 2: Hyponatremia and hyperkalemia in a four-week-old boy. Paediatr Child Health 2009; 13:387-90. [PMID: 19412367 DOI: 10.1093/pch/13.5.387a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2008] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mb Peddle
- Department of Medicine, Division of Emergency Medicine
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Kashimada K, Omori T, Takizawa F, Mizutani S. Two cases of transient pseudohypoaldosteronism due to group B streptococcus pyelonephritis. Pediatr Nephrol 2008; 23:1569-70. [PMID: 18481108 DOI: 10.1007/s00467-008-0843-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 03/16/2008] [Accepted: 03/19/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45, Bunkyo-ku, Yushima, Tokyo, 103-0034, Japan.
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Asano T, Abe M, Asai M, Imai T, Kamisago M, Kuwabara K, Nakajima M, Murakami M, Fujino O. Urinary Tract Malformation and Infection with Hyperkalemia and Decreased Fractional Excretion of Potassium in an Infant. J NIPPON MED SCH 2006; 73:289-91. [PMID: 17106181 DOI: 10.1272/jnms.73.289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe an uncircumcised male infant treated for urinary tract infection who exhibited multiple hormonal and electrolyte abnormalities consistent with a diagnosis of transient pseudohypoaldosteronism. Successful treatment of the urinary tract infection was accompanied by the resolution of all hormonal and electrolyte abnormalities, including hyperaldosteronemia, hyperreninemia, hyponatremia and hyperkalemia. Radiographic examination revealed marked left dilatation of the renal pelvis and hydroureter but no vesicoureteral reflux. Owing to the possibilities of future renal scarring, decreased renal function, and hypertension, evaluation of urinary tract malformation and appropriate hormonal studies should be performed in infants with urinary tract infection and hyperkalemia.
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Affiliation(s)
- Takeshi Asano
- Department of Pediatrics, Nippon Medical School Graduate School of Medicine, Chiba, Japan.
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