Abu Bakar Karmila, Jalaludin Muhammad Y, Zainal Nur, Woon Sze L, Mohd Zikre Nurwahida, Samingan Nurshadia, Ab Rahman Syaza, Eng Caroline S Y
Paediatric Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Paediatric Unit, Hospital Tuanku Ja'afar, Seremban, Malaysia.
Front Pediatr. 2021 May 5;9:655010. doi: 10.3389/fped.2021.655010. eCollection 2021.
Many reports on investigations and treatments in UTI, however little, have been mentioned with regard to electrolyte abnormalities. Secondary pseudohypoaldosteronism (PHA) in UTI, though less common, is a known association. Features include hyponatremia and concomitant hyperkalemia. We aim to highlight these uncommon sequelae in UTI to avoid incorrect diagnosis and unnecessary investigations. Clinical data of patients admitted and referred to a pediatric nephrologist at the University Malaya Medical Center between May 2019 and October 2020 were collated and elaborated. We report three infants with hyponatremia and hyperkalemia during UTI episodes. Two infants were known to have posterior urethral valve (PUV) before the onset of UTI and one infant had UTI, which led to investigations confirming the diagnosis of bladder vaginal fistula. The electrolyte derangements were temporary and resolved within 48 to 72 h of treatment with intravenous fluid and appropriate antibiotic therapy. Out of three, only one had a hormonal study, which confirms PHA. Reduced aldosterone activity could be due to absolute reduction in aldosterone titer or lack of aldosterone responsiveness at tubular (other tissues) level. In the latter, aldosterone titer is elevated. The infant in our cohort who had hormonal evaluation had the mentioned electrolyte abnormalities with a markedly elevated aldosterone titer. This demonstrated defective action of the hormone at the level of mineralocorticoid receptor. Although the remaining two infants had no confirmatory hormonal study, all of them recovered within 48 h of hospital admission, after receiving appropriate management for the primary problem, which was UTI. We observed a slower recovery of hyponatremia in relation to hyperkalemia, but none of these infants required salt replacement upon discharge. Infants with severe UTI and deranged electrolytes should be screened for structural abnormality and vice versa. Not all infants require hormonal screening, but those who required prolonged salt replacement or showed involvement of other systems warrant further evaluation.
然而，关于尿路感染（UTI）的调查和治疗的许多报告中，虽提及了电解质异常，但内容很少。UTI继发的假性醛固酮减少症（PHA）虽不常见，但却是一种已知的关联。其特征包括低钠血症和伴随的高钾血症。我们旨在强调UTI中这些不常见的后遗症，以避免错误诊断和不必要的检查。整理并详细阐述了2019年5月至2020年10月期间在马来亚大学医学中心住院并转诊至儿科肾病专家处的患者的临床资料。我们报告了3例在UTI发作期间出现低钠血症和高钾血症的婴儿。2例婴儿在UTI发作前已知患有后尿道瓣膜（PUV），1例婴儿发生UTI，经检查确诊为膀胱阴道瘘。电解质紊乱是暂时的，在静脉补液和适当的抗生素治疗后48至72小时内得到缓解。3例中只有1例进行了激素研究，证实为PHA。醛固酮活性降低可能是由于醛固酮滴度绝对降低或肾小管（其他组织）水平缺乏醛固酮反应性。在后一种情况下，醛固酮滴度升高。我们队列中接受激素评估的婴儿出现了上述电解质异常，醛固酮滴度明显升高。这表明该激素在盐皮质激素受体水平存在作用缺陷。尽管其余2例婴儿未进行确诊性激素研究，但在接受针对主要问题UTI的适当治疗后，他们均在入院48小时内康复。我们观察到低钠血症的恢复相对于高钾血症较慢，但这些婴儿出院时均无需补充盐分。患有严重UTI和电解质紊乱的婴儿应筛查结构异常，反之亦然。并非所有婴儿都需要进行激素筛查，但那些需要长期补充盐分或出现其他系统受累的婴儿需要进一步评估。
