Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Vico Luigi De Crecchio 2, 80138, Naples, Italy.
Pediatric Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy.
Eur J Pediatr. 2024 Dec;183(12):5223-5232. doi: 10.1007/s00431-024-05784-0. Epub 2024 Oct 2.
We aimed to assess the prevalence of and factors associated with Na + /K + imbalances in children hospitalized for febrile urinary tract infection (fUTI). This retrospective Italian multicenter study included children aged 18 years or younger (median age = 0.5 years) who were discharged with a primary diagnosis of fUTI. Na + /K + imbalances were classified as hyponatremia (sodium < 135 mEq/L), hypernatremia (sodium > 145 mEq/L), hypokalemia (potassium < 3.5 mEq/L), hyperkalemia (potassium > 5.5 mEq/L), and concurrent hyponatremia and hyperkalemia, in the absence of evidence of hemolyzed blood samples. Among the 849 enrolled children, 23% had hyponatremia, 6.4% had hyperkalemia, 2.9% had concurrent hyponatremia and hyperkalemia, 0.7% had hypokalemia, and 0.4% had hypernatremia. In the multiple logistic regression analysis, after applying the Bonferroni correction, only C-reactive protein (C-RP) levels were significantly associated with hyponatremia (OR = 1.04; 95% CI: 1.02-1.06; p < 0.001), only age was significantly associated with hyperkalemia (OR = 1.7; 95% CI: 1.1-2.7; p = 0.01), and only CAKUT was significantly associated with concurrent hyponatremia and hyperkalemia (OR = 4.3; 95% CI: 1.7-10.8; p = 0.002). Even after adjusting for the presence of kidney hypoplasia, abnormal renal echogenicity, pelvi-caliceal dilation, ureteral dilation, uroepithelial thickening of the renal pelvis, bladder abnormalities, pathogen other than E. coli, concurrent hyponatremia and hyperkalemia persisted significantly associated with CAKUT (OR = 3.6; 95% CI: 1.2-10.9; p = 0.02).
Hyponatremia was the most common Na + /K + imbalance in children hospitalized for fUTI, followed by hyperkalemia and concurrent hyponatremia and hyperkalemia. C-RP levels were most strongly associated with hyponatremia, age with hyperkalemia, and CAKUT with concurrent hyponatremia and hyperkalemia (suggestive of transient secondary pseudo-hypoaldosteronism). Therefore, in children who develop concurrent hyponatremia and hyperkalemia during the course of a fUTI, an underlying CAKUT could be suspected.
• Na+ and K+ abnormalities can occur in patients hospitalized for febrile urinary tract infection (fUTI). • Concurrent hyponatremia and hyperkalemia during fUTI may suggest transient secondary pseudo-hypoaldosteronism (TPHA), for which limited data on prevalence are available.
• The most common Na+/K+ imbalance in children hospitalized with fUTI was hyponatremia (23%), followed by hyperkalemia (6.4%), concurrent hyponatremia and hyperkalemia (2.9%), hypokalemia (0.7%), and hypernatremia (0.4%). • Concurrent hyponatremia and hyperkalemia were mainly associated with CAKUT, while hyponatremia alone correlated with high C-reactive protein and hyperkalemia alone with younger age. In cases of concurrent hyponatremia and hyperkalemia during fUTI, an underlying CAKUT should be suspected.
评估儿童因发热性尿路感染（fUTI）住院时钠/钾失衡的流行率及其相关因素。本回顾性意大利多中心研究纳入了年龄在 18 岁或以下（中位数年龄=0.5 岁）且出院时诊断为 fUTI 的儿童。将钠/钾失衡分为低钠血症（钠<135mEq/L）、高钠血症（钠>145mEq/L）、低钾血症（钾<3.5mEq/L）、高钾血症（钾>5.5mEq/L）以及在无溶血证据的情况下同时存在低钠血症和高钾血症。在纳入的 849 名患儿中，23%存在低钠血症，6.4%存在高钾血症，2.9%存在同时存在低钠血症和高钾血症，0.7%存在低钾血症，0.4%存在高钠血症。在多因素逻辑回归分析中，在应用 Bonferroni 校正后，只有 C 反应蛋白（C-RP）水平与低钠血症显著相关（OR=1.04；95%CI：1.02-1.06；p<0.001），只有年龄与高钾血症显著相关（OR=1.7；95%CI：1.1-2.7；p=0.01），只有 CAKUT 与同时存在低钠血症和高钾血症显著相关（OR=4.3；95%CI：1.7-10.8；p=0.002）。即使在调整了肾发育不全、肾实质回声异常、肾盂扩张、输尿管扩张、肾盂输尿管上皮增厚、膀胱异常、大肠埃希菌以外的病原体的存在后，同时存在低钠血症和高钾血症与 CAKUT 仍然显著相关（OR=3.6；95%CI：1.2-10.9；p=0.02）。
儿童因 fUTI 住院时最常见的钠/钾失衡是低钠血症（23%），其次是高钾血症和同时存在低钠血症和高钾血症。C-RP 水平与低钠血症最相关，年龄与高钾血症最相关，CAKUT 与同时存在低钠血症和高钾血症最相关（提示短暂性继发性假性醛固酮增多症）。因此，在因 fUTI 住院的患儿同时出现低钠血症和高钾血症时，可能怀疑存在 CAKUT。
• 发热性尿路感染（fUTI）患者可能出现钠和钾异常。
• 在 fUTI 期间同时出现低钠血症和高钾血症可能提示短暂性继发性假性醛固酮增多症（TPHA），但目前有关其流行率的资料有限。
• 儿童因 fUTI 住院时最常见的钠/钾失衡是低钠血症（23%），其次是高钾血症（6.4%）、同时存在低钠血症和高钾血症（2.9%）、低钾血症（0.7%）和高钠血症（0.4%）。
• 同时存在低钠血症和高钾血症主要与 CAKUT 相关，而低钠血症单独与 C 反应蛋白升高相关，高钾血症单独与年龄较小相关。在 fUTI 期间同时出现低钠血症和高钾血症时，应怀疑存在 CAKUT。
