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960 Secondary Pseudohypoaldosteronism Due to Pyelonephritis: Two Cases Report
  1. I Llana1,
  2. MD Sanchez-Redondo2,
  3. M Benedit1,
  4. J Cobas2,
  5. MT Garcia de Alvaro1
  1. 1Hospital HM Torrelodones, Madrid
  2. 2Hospital Virgen de la Salud, Toledo, Spain

Abstract

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.

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