Reversible secondary pseudohypoaldosteronism due to pyelonephritis

Abstract

We report a 5-week-old boy who developed severe hyponatremia and hyperkalemia secondary to acute pyelonephritis. The patient presented with non-specific signs, including poor appetite, failure to thrive, and dehydration. An endocrinological evaluation led to a diagnosis of pseudohypoaldosteronism. The patient had phimosis, but no congenital urinary tract malformations. Outflow obstruction secondary to the phimosis appears to have caused pyelonephritis, and renal inflammation decreased responsiveness to aldosterone transiently.

Electrolyte disturbances in acute pyelonephritis

“…A differential diagnosis may be achieved by acute analysis of urine culture and renal ultrasonography. [1], several clinical cases of children have been reported in the literature, mostly in association with urinary tract anatomical abnormalities, acute pyelonephritis, or the combination of both [2][3][4][5][6][7][8][9][10][11][12][13][14]. However, more pediatric specialists should become aware of this condition and its natural history.…”

“…However, more pediatric specialists should become aware of this condition and its natural history. Most of the published reports have been on clinically isolated patients [3][4][5][6][7][8][9][10][11][12][13][14]; however Rodríguez Soriano and colleagues [2] carried out an analytical study comparing electrolytic disturbances among patients with pyelonephritis with a control group of age-matched healthy children. Their study was limited by the small number of patients, and until now no independent analysis and demographic characterization of the secondary PHA subgroup of patients had been performed.…”

“…Secondary PHA due to renal unresponsiveness to aldosterone produces a renal saltlosing state with hyponatremia, hyperkalemia, acidosis, and high levels of plasma renin activity and aldosterone. However, it has also been observed in patients with urinary tract obstruction, hydronephrosis, and vesicoureteral reflux without urinary tract infection [11][12][13][14]. A high intrarenal pressure in the renal tubules is considered to be the likely pathogenesis of this renal dysfunction, leading to tubular resistance to aldosterone [1,2,12,15].…”

Two cases of transient pseudohypoaldosteronism due to group B streptococcus pyelonephritis

“…Most patients are younger than 3 months of age, which suggests that immature renal tubules may be responsible for the severe resistance to aldosterone resulting in TPHA. However, the precise mechanisms underlying TPHA have not yet been determined [3].…”

Transient Pseudohypoaldosteronism in an Infant: A Case Report

“…6 Watanabe in his review documented that all patients were younger than 7 months and 80% of them suffered from both urinary tract malformation and associated UTI similar to our case. 7 Some cases of transient PHA in infants with UTI who had urinary tract abnormalities were previously documented. 8,9 Schoen et al, also discussed that the resolution of all hormonal and electrolyte abnormalities was followed by successful treatment of UTI in infants, which was similar to our case.…”