Transient secondary pseudo-hypoaldosteronism in infants with urinary tract infections: systematic literature review

Abstract

Infants with a congenital anomaly of the kidney and urinary tract sometimes present with hyponatremia, hyperkalemia, and metabolic acidosis due to under-responsiveness to aldosterone, hereafter referred to as secondary pseudo-hypoaldosteronism. The purpose of this report is to investigate pseudo-hypoaldosteronism in infant urinary tract infection. A systematic review was conducted following PRISMA guidelines after PROSPERO (CRD42022364210) registration. The National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar without limitations were used. Inclusion criteria involved pediatric cases with documented overt pseudo-hypoaldosteronism linked to urinary tract infection. Data extraction included demographics, clinical features, laboratory parameters, management, and course. Fifty-seven reports were selected, detailing 124 cases: 95 boys and 29 girls, 10 months or less of age (80% of cases were 4 months or less of age). The cases exhibited hyponatremia, hyperkalemia, acidosis, and activated renin-angiotensin II-aldosterone system. An impaired kidney function was found in approximately every third case. Management included antibiotics, fluids, and, occasionally, emergency treatment of hyperkalemia, hyponatremia, or acidosis. The recovery time averaged 1 week for electrolyte, acid-base imbalance, and kidney function. Notably, anomalies of the kidney and urinary tract were identified in 105 (85%) cases.

Conclusions: This review expands the understanding of overt transient pseudo-hypoaldosteronism complicating urinary tract infection. Management involves antimicrobials, fluid replacement, and consideration of electrolyte imbalances. Raising awareness of this condition within pediatric hospitalists is desirable.

What is known: • Infants affected by a congenital anomaly of the kidney and urinary tract may present with clinical and laboratory features resembling primary pseudo-hypoaldosteronism. • Identical features occasionally occur in infant urinary tract infection.

What is new: • Most cases of secondary pseudo-hypoaldosteronism associated with a urinary tract infection are concurrently affected by a congenital anomaly of the kidney and urinary tract. • Treatment with antibiotics and parenteral fluids typically results in the normalization of sodium, potassium, bicarbonate, and creatinine within approximately 1 week.

Keywords: Acidosis; Hyperkalemia; Hyponatremia; Under-responsiveness to aldosterone; Urinary tract infection.

Fig. 1

Secondary pseudo-hypoaldosteronism in children with a urinary tract infection. Flowchart of the literature search

Fig. 2

Age and sex distribution in 124 infants (95 boys and 29 girls) affected by pseudo-hypoaldosteronism secondary to a urinary tract infection

Fig. 3

Standard deviation scores for sodium, potassium, bicarbonate, creatinine, urea, aldosterone, and renin in infants affected by pseudo-hypoaldosteronism secondary to a urinary tract infection. A logarithmic scale was chosen for creatinine, urea, aldosterone, and renin. Data are presented both as individual values and as boxplots (the lower and upper boundaries of the box signify the 25th and 75th percentiles, respectively; the central line within the box represents the median, while the extremities of the whiskers indicate the 3rd and 97th percentiles). Open symbols represent a normal, while filled symbols indicate a pathologically altered result