Premium
Transient pseudohypoaldosteronism in infancy secondary to urinary tract infection
Author(s) -
Abraham Mary B,
Larkins Nicholas,
Choong Catherine S,
Shetty Vinutha B
Publication year - 2017
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13481
Subject(s) - medicine , congenital adrenal hyperplasia , pseudohypoaldosteronism , failure to thrive , hydronephrosis , urinary system , pediatrics , hyperkalemia
Aim Hyponatraemia with hyperkalaemia in infancy is a typical presentation of congenital adrenal hyperplasia. In the presence of pyelonephritis, the same biochemical picture can occur with transient type 1 pseudohypoaldosteronism ( PHA ‐1) also termed type 4 renal tubular acidosis. Recognition of PHA ‐1 enables appropriate management thus avoiding unnecessary investigations and treatment. To improve awareness of this condition, we present a case series to highlight the clinical and biochemical features of PHA ‐1. Methods A retrospective chart review of patients diagnosed with transient PHA ‐1 at a tertiary children's hospital in Western Australia was conducted. Results Five male infants (32 days to 6 months) with transient PHA ‐1 were identified. Failure to thrive was the most common symptom with hyponatraemia on presentation. Two infants had antenatally diagnosed bilateral hydronephrosis and urinary tract infection ( UTI ) on admission. Two infants were treated for congenital adrenal hyperplasia and received hydrocortisone. All infants had UTI and required parenteral antibiotics. The condition was transient and hyponatraemia corrected by day 4 in all infants. There was no correlation between plasma sodium and aldosterone levels. The severity of PHA ‐1 was independent of the underlying renal anomaly. Four infants had hydronephrosis and vesicoureteric reflux. Surgical intervention was required in two infants. Conclusions PHA ‐1 may be precipitated by UTI or urinary tract anomalies in early infancy. Urine analysis should be performed in infants with hyponatraemia. Diagnosis of PHA ‐1 facilitates appropriate renal investigations to reduce long‐term morbidity.