Child Kidney Dis > Volume 18(2); 2014 > Article
J Korean Soc Pediatr Nephrol 2014;18(2): 111-115. doi:
Management of a 25-day-old Male Presenting with a First Episode of Acute Pyelonephritis, and Persistent Hyperkalemia with Normal Serum Aldosterone
Yu Sun Kang, Ji Yeon Choi, Jun Ho Lee
Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, KOREA
Corresponding Author: Jun Ho Lee ,Tel: +82-31-780-5011, Fax: +82-31-780-6262, Email:
Received: August 24, 2014;  Accepted: October 1, 2014.
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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 nonspecific, 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.
Key words: Fludrocortisone | Hyperkalemia | Infant | Pyelonephritis | Vesicoureteral reflux
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