Melzi M L, Guez S, Sersale G, Terzi F, Secco E, Marra G, Tirelli A S, Assael B M
Department of Pediatrics, University of Milan, Italy.
Pediatr Infect Dis J. 1995 Jan;14(1):56-9. doi: 10.1097/00006454-199501000-00012.
Obstructive uropathy causes tubular resistance to aldosterone and severe metabolic imbalance may be precipitated by an episode of pyelonephritis. In the last 3 years we investigated 52 episodes of pyelonephritis (positive urine culture, elevated C reactive protein, fever, elevated neutrophil count) in 50 children between 15 days and 15 months of age. Ultrasonography voiding cystography and renal scintiscan were performed in all cases and i.v. urography in some. A salt-losing syndrome with hyponatremia and hyperkalemia (Na < 125 meq/liter; K > 6.3 meq/liter) was observed in 17 infants < 3 months, accompanied by plasma aldosterone concentration of 5000 to 23,000 pg/ml (normal value, < 1000 pg/ml). All these children had a severe urinary tract (UT) malformation (ureteropelvic junction stenosis in 7 cases, vesicoureteral reflux in 7, posterior urethral valves in 2, double system in 1). Thirteen infants < 3 months, 7 with no urinary tract malformations, did not have electrolyte imbalance. Pyelonephritis was diagnosed in 20 other patients ages 4 to 15 months, including 16 with severe UT malformations; 4 had normal UTs. We conclude that a salt-losing syndrome with tubular resistance to aldosterone can occur during pyelonephritis in young infants with congenital UT malformation, that the risk diminishes considerably or disappears after 3 months of age and that in the absence of UT malformation pyelonephritis does not cause acute sodium loss of clinical relevance.
梗阻性尿路病可导致肾小管对醛固酮产生抵抗，肾盂肾炎发作可能会引发严重的代谢失衡。在过去3年里，我们对50名年龄在15天至15个月之间的儿童的52次肾盂肾炎发作情况（尿培养阳性、C反应蛋白升高、发热、中性粒细胞计数升高）进行了调查。所有病例均进行了超声检查、排尿性膀胱尿道造影和肾闪烁扫描，部分病例进行了静脉肾盂造影。在17名3个月以下的婴儿中观察到了伴有低钠血症和高钾血症（钠<125毫当量/升；钾>6.3毫当量/升）的失盐综合征，其血浆醛固酮浓度为5000至23000皮克/毫升（正常值，<1000皮克/毫升）。所有这些儿童都有严重的泌尿系统（UT）畸形（7例为肾盂输尿管连接处狭窄，7例为膀胱输尿管反流，2例为后尿道瓣膜，1例为重复肾）。13名3个月以下的婴儿中，7名没有泌尿系统畸形，没有出现电解质失衡。另外20名年龄在4至15个月的患者被诊断为肾盂肾炎，其中16名有严重的UT畸形；4名UT正常。我们得出结论，先天性UT畸形的幼儿在患肾盂肾炎期间可能会出现肾小管对醛固酮产生抵抗的失盐综合征，3个月龄后这种风险会大幅降低或消失，并且在没有UT畸形的情况下，肾盂肾炎不会导致具有临床意义的急性钠丢失。
