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Moreno Sánchez A, García Atarés Á, Molina Herranz D, Antoñanzas Torres I, Romero Salas Y, Ruiz Del Olmo Izuzquiza JI. Secondary pseudohypoaldosteronism: a 15-year experience and a literature review. Pediatr Nephrol 2024; 39:3233-3239. [PMID: 38937297 DOI: 10.1007/s00467-024-06428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Secondary pseudohypoaldosteronism (S-PHA) is a rare condition resulting from renal tubular resistance to aldosterone in children with urinary tract infection (UTI) and/or nephrourological malformations. It is characterized by nonspecific symptoms but with the potential for life-threatening complications. We aim to evaluate the clinical manifestations, diagnostic approach, and therapeutic interventions in children with S-PHA, along with a review of recent publications. METHODS A retrospective observational descriptive study was conducted on S-PHA cases diagnosed over the last 15 years at a tertiary pediatric nephrology unit. The literature for the last 10 years was reviewed. RESULTS Twelve patients (10 males, 6 days to 6 months) were identified. Weight loss was the main reason for consultation (50%). Ninety-two percent of patients had an underlying nephrourological pathology and 62% concomitant confirmed UTI. Seven out of 12 children were admitted to the PICU. A subsequent extrapontine myelinolysis was observed in one patient as neurological sequelae. Twenty-one articles related to S-PHA have been identified on PubMed and Embase. CONCLUSIONS S-PHA should be considered in infants under 6 months of age with UTI and/or CAKUT. Obstructive anomalies and vesicoureteral reflux can be found, affecting both unilateral and bilateral systems. Early medical and surgical interventions are crucial and require close monitoring to avoid iatrogenic complications.
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Affiliation(s)
- Amelia Moreno Sánchez
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain.
| | - Álvaro García Atarés
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - David Molina Herranz
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - Irene Antoñanzas Torres
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - Yolanda Romero Salas
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
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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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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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González-Bertolín I, Barbas Bernardos G, García Suarez L, López López R, García Sánchez P, Bote Gascón P, Calvo C. Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children. Eur J Pediatr 2023; 182:4867-4874. [PMID: 37587378 PMCID: PMC10640435 DOI: 10.1007/s00431-023-05149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6-26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia. CONCLUSION Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations. WHAT IS KNOWN • Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation. • Hyponatremia could be a marker to identify these children and guide the imaging approach. WHAT IS NEW • Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation. • Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.
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Affiliation(s)
| | | | - Leire García Suarez
- Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
- Pediatric Nephrology Department, Fuerteventura Virgen de la Peña General Hospital, Fuerteventura, Spain
| | | | | | | | - Cristina Calvo
- Pediatrics and Infectious Disease Department, La Paz University Hospital, IdiPaz Foundation. Traslational Research Network in Pediatric Infectious Diseases (RITIP), CIBERINFEC. ISCIII, Madrid, Spain
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Fujioka K, Nakasone R, Nishida K, Ashina M, Sato I, Nozu K. Neonatal Pseudohypoaldosteronism Type-1 in Japan. J Clin Med 2022; 11:jcm11175135. [PMID: 36079066 PMCID: PMC9456610 DOI: 10.3390/jcm11175135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Pseudohypoaldosteronism type 1 (PHA-1) is a disorder caused by renal tubular resistance to aldosterone and is characterized by problems with sodium regulation. PHA-1 is typically divided into primary PHA-1, which is caused by genetic mutation, and secondary PHA-1, which is associated with urinary tract abnormality. However, data on the clinical features of PHA-1 among newborn infants are limited. (2) Methods: We conducted a nationwide prospective surveillance study of neonatal PHA in Japan from 1 April 2019 to 31 March 2022 as part of a rare disease surveillance project of the Japan Society for Neonatal Health and Development. (3) Results: Fifteen cases (male:female = 7:8), including four primary, four secondary, and seven non-classified cases, were reported during the study period. The median gestational age and birthweight were 34 weeks (28–41) and 1852 g (516–4610), respectively. At the onset, the median serum Na and K levels were 132 mEq/L (117–137) and 6.3 mEq/L (4.7–8.3), respectively. The median plasma renin activity was 45 ng/mL/h (3.1–310, n = 9), active renin concentration was 1017 pg/mL (123–2909, n = 6), and serum aldosterone concentration was 5310 pg/mL (3250–43,700). (4) Conclusions: Neonatal PHA-1 was more common among preterm infants with no male predominance. It developed immediately after birth in cases without genetic or renal complications.
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Affiliation(s)
- Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
- Correspondence: ; Tel.: +81-78-382-6090
| | - Ruka Nakasone
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kosuke Nishida
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Mariko Ashina
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Itsuko Sato
- Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Tuoheti Y, Zheng Y, Lu Y, Li M, Jin Y. Transient pseudohypoaldosteronism in infancy mainly manifested as poor appetite and vomiting: Two case reports and review of the literature. Front Pediatr 2022; 10:895647. [PMID: 36090572 PMCID: PMC9452901 DOI: 10.3389/fped.2022.895647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Transient Pseudohypoaldosteronism (TPHA) is a very rare condition usually secondary to urinary tract malformations (UTM) and/or urinary tract infection (UTI). It is characterized by hyperkalemia, hyponatremia, metabolic acidosis, and elevated plasma aldosterone levels. Given that the predominant manifestations of TPHA patients are digestive tract symptoms, such as poor appetite, vomiting, and weight gain, it is easily misdiagnosed as digestive tract diseases. CASE REPORTS Two children with poor appetite and vomiting were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University, from 2020 to 2021. Laboratory test results of these two children revealed hyponatremia (< 135.00 mmol/L), hyperkalemia (> 5.50 mmol/L), and hyperaldosteronism (> 180.00 ng/L). Moreover, genetic tests demonstrated no genetic variants highly associated with the phenotype in both cases. The two patients were subsequently treated with electrolyte correction. One of them also treated with antibiotics and one of them underwent surgery. They were followed for 8 and 4 months, respectively. No complications were observed during the follow-up period. This review aimed to outline both cases with parental consent. CONCLUSION Transient pseudohypoaldosteronism should be considered in children younger than 6 months, presenting with vomiting, poor appetite, unexplained hyponatremia, hyperkalemia, elevated aldosterone levels, and urethral malformation or urinary tract infection. Furthermore, attention should be paid to whether salt supplementation or anti-infection therapy is effective.
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Affiliation(s)
- Yueerlanmu Tuoheti
- Medical School of Nanjing University, Nanjing, China.,Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yucan Zheng
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Jin
- Medical School of Nanjing University, Nanjing, China.,Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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