Abstract: PUB467
A Rare Presentation: Male Neonate with Severe Bilateral Hydronephrosis and Normokalemic Acute Renal Tubular Acidosis
Session Information
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Gutierrez-Lorea, Victoria, Ponce Health Sciences University, Ponce, Puerto Rico, United States
- Perez Mena, Carol Elaine, Ponce Health Sciences University, Ponce, Puerto Rico, United States
- Rodriguez, Jose A., Hospital Episcopal San Lucas, Ponce, Puerto Rico, United States
Introduction
Among the most common causes of hydronephrosis in neonates are birth defects that lead to Ureteropelvic Junction obstruction (UPJ) and Vesicoureteral Reflux (VUR). If the obstructive uropathy is chronic, renal tubules lose their function leading to Renal Tubular Acidosis (RTA). Here we present a male neonate who presented with severe bilateral hydronephrosis which caused acute RTA.
Case Description
A male newborn patient born at 37 weeks gestational age with perinatal diagnosis of bilateral hydronephrosis and unremarkable physical exam was admitted for evaluation. Protocole laboratories, showed abnormal BUN (16 mg/dl), creatinine level (1.71 mg/dl) and normal values of potassium. The patient started exhibiting progressive decline in Carbon dioxide (CO2) levels despite adequate feeding and intravenous fluids. Acute RTA was suspected. ABG showing mild metabolic acidosis (PH 7.29, HCO3 21, CO2 44), ammonia levels at 40 mg/dl and unremarkable urine analysis. Patient was started on Sodium Citrate at 2mEq/kgdose every 8 hours. Result of Voiding Cysto-Urethrogram (VCUG) is seen on Figure 1. Patient was transferred to another facility for further evaluation.
Discussion
Severe bilateral hydronephrosis caused by UPJ and VUR which consequently leads to acute RTA is extremely rare in a neonate. We believe chronic obstructive nephropathy led to RTA with severe renal impairment. Although one hallmark of RTA is hypokalemia, the hypokalemic levels were likely masked by the administration of Sodium Citrate. Healthcare providers should be aware of unreliable potassium values in RTA patients taking sodium citrate.
Figure 1: VCUG shows severe reflux from the right-sided ureter and significant dilation of the renal pelvic, calyces and infundibulum. No reflux is evident on the left.