ESPN 51th Annual Meeting

ESPN 2018


 
Transient Type 4 Renal Tubular Acidosis Associated With Pyohydronephrosis in an Infant
EREN SOYALTIN 1 BELDE KASAP DEMIR 2 DEMET ALAYGUT 1 MURAT UÇAR 3 FATMA MUTLUBAŞ 1 ÖNDER YAVAŞCAN 1 CANER ALPARSLAN 1 SEÇIL ARSLANSOYU ÇAMLAR 1

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, İZMIR, TURKEY
2- İZMIR KATIP ÇELEBI UNIVERSITY DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, İZMIR, TURKEY
3- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRIC UROLOGY, IZMIR, TURKEY
 
Introduction:

Hyponatraemia with hyperkalaemia and metabolic asidosis is a typical presentation of type 4 renal tubular acidosis that is most commonly diagnosed in the context of urinary tract infection (UTI) or obstructive uropathy. We described an infant who presented with UTI complicating corrected unilateral ureteropelvic obstruction, which may have a strong association with type 4 renal tubular acidosis.

Material and methods:

Results:

 A 3-month-old girl was admitted with fever and poor feeding.  It was learned that the patient has had a pyeloplasty operation for left ureteropelvic junctional stenosis and there was still a JJ catheter between the renal pelvis and the bladder. On physical examination she had weakness, reluctant to breastfeeding and the body temperature was 38.5 C, however she was haemodynamically stable. Her blood pressure was 82/48 mm Hg. No pathologic findings were found in other systemic examinations. The dipstick urine analysis revealed +3 leukocyte esterase and + nitrite test. The blood sample demonstrated hyponatraemia (Na 124 mmol/L), hyperkalaemia (K 6.7 mmol/L), and mild metabolic acidosis (pH 7.28; bicarbonate 13 mmol/L). Renal function tests were normal, renal imaging confirmed a pyohydronephrosis in the left renal pelvis. Intravenous fluids and bicarbonate replacement were commenced. Antibiotics were instituted for UTI and the JJ catheter was removed. The patients clinical condition improved and sodium, potassium levels and blood gasses analyses normalised by day 4 of admission. During the follow-up period the patient underwent nephrostomy catheter insertion for persistent pyohydronephrosis in consecutive renal ultrasonographic images. The catheter was removed after pelvic drainage and urinary sterilization.

Conclusions:

Type 4 renal tubular acidosis can be precipitated by urinary tract anomalies or UTI in early infancy. Any infant presenting with hyponatraemia, hyperkalaemia with or without acidosis, should be evaluated for UTI or anatomic disorders with urine culture and renal ultrasound