Hyponatremia with hyperkalemia in infancy may be seen in many endocrinologic and metabolic disorder such as congenital adrenal hyperplasia, congenital adrenal hypoplasia, and other forms of hypoadrenalism in infancy. Here, we report a infants who presented with hyponatremia with hyperkalemia finally diagnosed as pseudohypoaldosteronism (PHA) due to urinary tract infection (UTI) with reflux nephropahy. A 5-month-old female initially was transferred for poor weight gain for 2 months. The body weight was 5.0 kg (<3rd percentile). She looks pale and not well-being. Virilization of genitalia or pigmentation were not noted. Initial serum sodium was decreased (125 mEq/l) and serum potassium was elevated (6.1 mEq/l). The serum CRP level was elevated (4.08 mg/dl), and serum ESR level was also elevated (60 mm/h). Urine analysis revealed pyuria. Intravenous saline and antibiotics were started after urine culture. Catheter urine culture was positive for Serratia marcescens. The initial serum 17-Hydroxyprogesterone level was 0.73 ng/ml and aldosterone level was markedly elevated 17,800 pg/ml (normal: 30900), urinary sodium centration was 30 mg/l, so pseudohypoaldosteronism (PHA) was diagnosed. Her serum sodium and potassium were normalized after 48 h of intravenous fluid and antibiotics therapy, and inflammatory markers were also normalized. The VCUG showed right-sided grade 5 and left-sided grade 4 vesicoureteral reflux, the renal sonography showed mild atrophy of right kidney and compensatory hypertrophy of left kidney. The electrolyte levels remained normal range and aldosterone level was decreased without sodium replacement and proper weight gain was achieved. It is important that transient PHA due to urinary tract infection should be considered in infant particularly after the first 1 month of life with hyponatremia and hyperkalemia without virilization.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology