engleski

Transient pseudohypoaldosteronism secondary to urinary tract infection in a male infant with unilateral hydronephrosis due to primary obstructive megaureter: case report

We present a case of the transient form of type 1 pseudohypoaldosteronism (S-PHA) in a 1, 5-month- old male infant who presented with lethargy, failure to thrive, severe hyponatremia (Na=118 mmol/L), hypochloremia (Cl=93 mmol/L), and fever due to urinary tract infection. Material and methods: Potassium levels were normal. Markedly elevated serum aldosterone level and elevated serum renin confirmed the diagnosis of pseudohypoaldosteronism. Renal ultrasound showed grade III hydronephrosis on the left kidney while contrast-enhanced voiding urosonography excluded the existence of vesicoureteral reflux which raised suspicion of obstructive uropathy on the level of vesicoureteral junction. Results: Serum sodium normalized after several days of intravenous fluids and antibiotic therapy after which oral supplementation of sodium was introduced. Levels of 17-hydroxyprogesterone, ACTH, cortisol, and TSH were normal. Functional MR urography conducted at the age of 3 months confirmed the diagnosis of primary congenital obstructive megaureter and the infant was referred to a pediatric surgeon. Conclusions: Although a rare occurrence, S-PHA can be a potentially life- threatening condition in infants if not recognized and treated adequately. Therefore, serum concentrations of electrolytes should be obtained in every child with a diagnosed obstructive anomaly of the urinary tract and/or acute cystopyelonephritis. On the other hand, every child with diagnosed S-PHA should be evaluated for the obstructive anomaly of the urinary tract.

pseudohypoaldosteronism ; infant ; obstructive anomaly ; cystopyelonephritis

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