Hyponatremia in childhood urinary tract infection
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ORIGINAL ARTICLE
Hyponatremia in childhood urinary tract infection Adi Pappo 1 & Rachel Gavish 1,2 & Ori Goldberg 2,3 & Efraim Bilavsky 1,2 & Zvi Bar-Sever 2,4 & Irit Krause 1,2 Received: 26 April 2020 / Revised: 6 September 2020 / Accepted: 11 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Acute urinary tract infection (UTI) is the most common bacterial infection in childhood. Although hyponatremia was described in ~ 2/3 of these children, its clinical significance is still unclear. Herein, we evaluated the prevalence and clinical implications of hyponatremia in children hospitalized with a UTI. Medical records of previously healthy children hospitalized between January 2011 and December 2016 with UTI were retrospectively reviewed. Patients (median age 5.5 months) were divided into two groups according to their sodium levels: normonatremia (Na ≥ 135 mEq/L) and hyponatremia (Na < 135 mEq/L). Hyponatremia diagnosed on admission was found in 114/219 children (49%). Hyponatremic patients experienced a more severe disease manifested by a longer hospital stay (3.8 vs 3.4 days, p = 0.003), a higher prevalence of abnormal findings on renal ultrasound (10 vs 2, p = 0.01), higher C-reactive protein (CRP) levels (8.6 vs 3.4 mg/dl, p = 2 years old). A positive result was based on the number of colony-forming units (CFU) that grew on the culture media, taking into consideration the method of collection (SPA > 102 CFU, transurethral catheter > 103 CFU, clean void male > 104 CFU, or clean void female > 105 CFU) [13]. Hyponatremia was defined as sodium blood levels < 135 mEq/L [1]. Mild hyponatremia was defined as sodium levels between 130 and 135 mEq/L and severe hyponatremia was defined as sodium levels < 120 mEq/L [6, 14]. Normal values of adjusted for age serum creatinine levels were classified by the Central Laboratory of the Schneider Children’s Medical Center of Israel. The presumptive diagnosis of secondary pseudohypoaldosteronism (PHA) was made in cases presenting at least two of the following biochemical abnormalities: sodium < 135 mEq/L, potassium > 5.4 mEq/L, and non-gap metabolic acidosis (pH < 7.40, bicarbonate < 20 mmol/L, and normal anion gap) [15]. Blood samples were taken on admission, prior to intravenous fluid administration. Severe disease was defined as the presence of any of the following: (1) renal complication: nephronia, abscess, or abnormal findings in the renal parenchyma observed on the ultrasound, i.e.,
hyperechoic cortex and/or lack of cortico-medullary differentiation and/or (2) hospitalization ≥ 7 days. A congenital anomaly of the kidneys and urinary tract (CAKUT) was defined as the presence of a pre-existing anatomic or functional defect including vesicoureteral reflux (VUR), neurogenic bladder, uretero-pelvic junction (UPJ) stenosis, uretero-vesical junction (UVJ) stenosis, posterior urethral valve, single kidney, renal dysplasia, or hypoplasia. Children with a CAKUT without elevated creatinine serum levels or tubular dysfunction prior to the episode of U
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