Management of a 25-day-old Male Presenting with a First Episode of Acute Pyelonephritis, and Persistent Hyperkalemia with Normal Serum Aldosterone
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Hyperkalemia is often detected in young infants, particularly in association with acute pyelonephritis or a urinary tract anomaly. Cases of hyperkalemia in this population may also be due to transient pseudohypoaldosteronism, or immaturity of renal tubules in handling potassium excretion. Symptoms of hyperkalemia are nonspecific, but are predominantly related to skeletal or cardiac muscle dysfunction, and can be fatal. Therefore, treatment has to be initiated immediately. Administration of fludrocortisone for hyperkalemia is appropriate in cases with hypoaldosteronism, but is challenging in young infants with hyperkalemia due to renal tubular immaturity, without pseudohypoaldosteronism. We report the case of a 25-day-old male presenting with persistent hyperkalemia with normal serum aldosterone, who was admitted with a first episode of pyelonephritis and unilateral high-grade vesicoureteral reflux. The patient was treated successfully with fludrocortisone.
Abstract
Hyperkalemia is often detected in young infants, particularly in association with acute pyelonephritis or a urinary tract anomaly. Cases of hyperkalemia in this population may also be due to transient pseudohypoaldosteronism, or immaturity of renal tubules in handling potassium excretion. Symptoms of hyperkalemia are nonspecific, but are predominantly related to skeletal or cardiac muscle dysfunction, and can be fatal. Therefore, treatment has to be initiated immediately. Administration of fludrocortisone for hyperkalemia is appropriate in cases with hypoaldosteronism, but is challenging in young infants with hyperkalemia due to renal tubular immaturity, without pseudohypoaldosteronism. We report the case of a 25-day-old male presenting with persistent hyperkalemia with normal serum aldosterone, who was admitted with a first episode of pyelonephritis and unilateral high-grade vesicoureteral reflux. The patient was treated successfully with fludrocortisone.
참고문헌 (14)
- 김문규, "Transient Pseudohypoaldosteronism in an Infant with Vesicoureteral Reflux", Childhood Kidney Diseases, 16(1), pp.54~57 (2012), 대한소아신장학회[DOI]
- Maruyama K, "Reversible secondary pseudohypoaldosteronism due to pyelonephritis", Pediatr Nephrol, 17, pp.1069~1070 (2002)
- Nandagopal R, "Transient pseudohypoaldosteronism due to urinary tract infection in infancy : A report of 4 cases", Int J Pediatr Endocrinol, 2009, pp.195728~ (2009)
- Geller DS, "Mineralocorticoid resistance", Clin Endocrinol, 62, pp.513~520 (2005)
- Thies KC, "Ventricular flutter in a neonate--severe electrolyte imbalance caused by urinary tract infection in the presence of urinary tract malformation", J Emerg Med, 18, pp.47~50 (2000)
- Klahr S, "The pathophysiology of obstructive nephropathy: the role of vasoactive compounds in the hemodynamic and structural abnormalities of the obstructed kidney", Am J Kidney Dis, 23, pp.219~223 (1994)
- Sperl W, "Changes in electrolyte and acid-base equilibrium in children with acute urinary tract infections", Padiatr Padol, 23, pp.121~128 (1988)
- Bonjour JP, "Interleukin-1 decreases renal sodium reabsorption:possible mechanism of endotoxin-induced natriuresis", Am J Physiol, 252, pp.943~946 (1987)
- Gerigk M, "Hyponatraemia and hyperkalaemia in acute pyelonephritis without urinary tract anomalies", European Journal of Pediatrics, 154, pp.582~584 (1995)
- Melzi ML, "Acute pyelonephritis as a cause of hyponatremia", hyperkalemia in young infants with urinary tract malformations, 1995, pp.14, 56~59
- West ML, "Development of a test to evaluate the transtubular potassium concentration gradient in the cortical collecting duct in vivo", Miner Electrolyte Metab, 12, pp.226~233 (1986)
- Gil-Ruiz MA, "Electrolyte disturbances in acute pyelonephritis", Pediatr Nephrol, 27, pp.429~433 (2012)
- Giebisch G, "Renal potassium transport: mechanisms and regulation", Am J Physiol, 274, pp.817~833 (1998)
- Liu D, "A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy", Allergy Asthma Clin Immunol, 9, pp.30~ (2013)