Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;97(36):e12152.
doi: 10.1097/MD.0000000000012152.

Antinatriuretic phenomena seen in children with acute pyelonephritis may be related to the activation of intrarenal RAAS

Jun Ho Lee  1 , Su Jin Jang, Seonkyeong Rhie
Affiliations

Antinatriuretic phenomena seen in children with acute pyelonephritis may be related to the activation of intrarenal RAAS

Jun Ho Lee et al. Medicine (Baltimore). 2018 Sep.

Abstract

We investigated whether antinatriuretic phenomena [decreases in urinary sodium (uNa) and fractional excretion of sodium (FENa)] seen in children with acute pyelonephritis (APN) are associated with the renin-angiotensin-aldosterone system (RAAS).We examined 114 children experiencing their first episode of febrile urinary tract infection (fUTI) consecutively admitted to our hospital from July 2012 to June 2014. Blood tests [C-reactive protein, white blood cell count, erythrocyte sedimentation rate, and aldosterone (Aldo)] and urine tests [uNa, urine potassium (uK) and FENa] were performed upon admission. All enrolled children underwent a 99m-dimercaptosuccinic acid renal scanning (DMSA) at admission. Areas with cortical defects (AreaCD) and uptake counts (UptakeCD) on their DMSA scans were calculated. Data were compared between children with positive DMSA results (APN), lower urinary tract infection (L-UTI), and controls; and between children with high and low Aldo levels.uNa, uNa/K, and FENa negatively correlated with AreaCD%, UptakeCD, and Aldo; were significantly lower in APN patients than in LUTIs and controls regardless of Aldo level; were lower in the high Aldo group than in the low Aldo group. However, there is no difference in AreaCD% and UptakeCD between APN children with the high and low Aldo level.Decreases in uNa, uNa/K, and FENa in children with APN may result from an antinatriuretic effect of RAAS and be related to the activation of the intrarenal RAAS.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The areas under the receiver operating characteristic (ROC) curves of relevant factors to predict acute pyelonephritis (APN) and their associated levels of significance.
Figure 2
Figure 2
A hypothetical diagram of the pathogenesis of acute pyelonephritis.
See this image and copyright information in PMC

References

    1. Tsao C, Huang W, Cheng C, et al. Evaluation of culture negative acute pyelonephritis with 99mTc-DMSA renal scan in children. Ann Nucl Med Sci 2003;16:117–22.
    1. Jung SJ, Lee JH. Prediction of cortical defect using C-reactive protein and urine sodium to potassium ratio in infants with febrile urinary tract infection. Yonsei Med J 2016;57:103–10. - PMC - PubMed
    1. Lee JH. Discrimination of culture negative pyelonephritis in children with suspected febrile urinary tract infection and negative urine culture results. J Microbil Immunol Infect 2017;[Epub ahead of print]. - PubMed
    1. Gupta G, Shapiro R, Girnita A, et al. Neutrophilic tubulitis as a marker for urinary tract infection in renal allograft biopsies with C4d deposition. Transplantation 2009;187:1013–8. - PubMed
    1. Backhed F, Söderhäll M, Ekman P, et al. Induction of innate immune responses by Escherichia coli and purified lipopolysaccharide correlated with organ and cell specific expression of Toll-like receptors within the human urinary tract. Cell Microbiol 2001;3:153–8. - PubMed

MeSH terms