Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Management of a 25-day-old Male Presenting with a First Episode of Acute Pyelonephritis, and Persistent Hyperkalemia with Normal Serum Aldosterone

급성신우신염으로 입원 후 지속적인 고칼륨혈증과 정상 혈중 알도스테론 수치를 보인 25일 영아 1례

  • Kang, Yu Sun (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Choi, Ji Yeon (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jun Ho (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine)
  • 강유선 (차의과대학교 분당차병원 소아청소년과) ;
  • 최지연 (차의과대학교 분당차병원 소아청소년과) ;
  • 이준호 (차의과대학교 분당차병원 소아청소년과)
  • Received : 2014.08.24
  • Accepted : 2014.10.01
  • Published : 2014.10.31
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Abstract

Hyperkalemia is often detected in young infants, particularly in association with acute pyelonephritis or a urinary tract anomaly. Cases of hyperkalemia in this population may also be due to transient pseudohypoaldosteronism, or immaturity of renal tubules in handling potassium excretion. Symptoms of hyperkalemia are non-specific, but are predominantly related to skeletal or cardiac muscle dysfunction, and can be fatal. Therefore, treatment has to be initiated immediately. Administration of fludrocortisone for hyperkalemia is appropriate in cases with hypoaldosteronism, but is challenging in young infants with hyperkalemia due to renal tubular immaturity, without pseudohypoaldosteronism. We report the case of a 25-day-old male presenting with persistent hyperkalemia with normal serum aldosterone, who was admitted with a first episode of pyelonephritis and unilateral high-grade vesicoureteral reflux. The patient was treated successfully with fludrocortisone.

요로기형 또는 급성신우신염이 있는 어린 영아에서 신세뇨관 기능 미성숙이나 일과성 가성저알도스테론혈증에 의해 고칼륨혈증이 흔하지 않게 발생할 수 있다. 고칼륨혈증은 증세가 뚜렷하지 않지만, 골격근이나 심장기능에 치명적인 영향을 줄 수 있어 즉각적인 처치를 필요로 한다. 고칼륨혈증 치료에 fludrocortisone을 적용하는 경우는 저알도 스테론혈증에 해당하였으나, 혈중 알도스테론농도 변화없이 세뇨관의 칼륨 배설 기능 미성숙에 의한 고칼륨혈증에 대한 사례는 문헌고찰상 없었다. 본 증례에서는 급성신우신염으로 입원한 후 지속적인 고칼륨혈증과 정상 혈중알도 스테론농도를 보인 25일 영아에서 fludrocortisone로 처치한 후 양호한 경과가 관찰되어 보고하는 바이다.

Keywords

References

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