Secondary pseudohypoaldosteronism occurs due to transient resistance in renal tubules causing renal sodium loss, hyponatremia and hyperkaliemia. This may resemble congenital adrenal hyperplasia. This is to be considered specially when a urinary tract infection is present as treatment and prognosis varies.
We report two infants who developed pseudohypoaldosteronism secondary to acute tract urinary infection and urologic malformations.
Patient 1 27 days old infant, weight: 4056 gr. He suffers severe dehydration, hyponatremia 119 mmol/L, K 7 mmol/L and metabolic acydosis, normal serum creatinine and normal 17 OH progest. Pathologycal urine analysis and hight leves of serum rennin and aldosterone. Urine culture: E.Coli. We can also apreciate left Ultrasonography hidronefrosis IV/V and primary megaureter. He was treated with Ampiciline + gentamicine and ions stabilisation within the following 36 hours after hospital admission.
Patient 2 14 days old infant, 2510 gr. Admitted at emergencies with a severe deshydration. Hyponatremia and hyperpotasemia that needed urgent treatment and severe metabolic acydosis. Electrolitic disorders were amended, then a urine culture was done with positive results in E. Coli test. He was treated with ampiciline + gentamicine. The renal scan evinced a bilateral ureteral hydronephrosis. The infant showed a recovery thanks to antibiotics treatment.
Conclusions An endocrinological evaluation is necessary to a diagnosis but we musn′t forget the urinary cultures.
Most probable cause is the inmature renal responsiveness to aldosterone in three first months of life when exist urinary tract anomalies and/or urinary tract infection.
This secondary pseudohypoaldosteronism is reversible with early treatment.