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Hyponatremia may reflect severe inflammation in children with febrile urinary tract infection

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Abstract

Background

Hyponatremia is the most common electrolyte abnormality in clinical practice, but little is known about the association between febrile urinary tract infection (UTI) and hyponatremia or its significance to clinical outcomes.

Methods

Data from 140 children with febrile UTI between 2000 and 2010 were retrospectively analyzed. Laboratory examinations [white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum sodium concentration], renal ultrasonography, 99mTechnetium-dimercaptosuccinic acid (DMSA) scintigraphy, and voiding cystourethrogram were performed. Culture growing >50,000 colonies of one single bacterial species on a urine sample obtained by catheter or >100,000 colonies on two clean-catch samples was required to establish diagnosis of UTI.

Results

In children with renal cortical defects diagnosed after DMSA scintigraphy (group 1), duration of fever was significantly longer (P = 0.038) and WBC (P = 0.047) and CRP (P < 0.0001) levels significantly higher than in those without renal cortical defects (group 2). However, serum sodium levels were significantly lower in group 1 than group 2 (135.9 ± 2.4 vs 137.4 ± 2.7 mEq/L, P = 0.007). Hyponatremia (serum sodium ≤135 mEq/L) was also more frequent in group 1 than in group 2 (74.1 % vs 45.3 %, P = 0.012). Serum sodium concentration was negatively correlated with WBC count (r = −0.156, P = 0.011) and CRP levels (r = −0.160, P = 0.028).

Conclusions

Our study indicates that hyponatremia may be a substantial inflammatory marker and is significantly and independently associated with the degree of inflammation in children with febrile UTI.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Declaration of interest

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Authors and Affiliations

  1. Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

    Se Jin Park

  2. Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Korea

    Yoon Soo Oh, Min Jeong Choi & Jae Il Shin

  3. Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, South Korea

    Kee Hyuck Kim

Authors
  1. Se Jin Park
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  2. Yoon Soo Oh
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  3. Min Jeong Choi
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  4. Jae Il Shin
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Corresponding authors

Correspondence to Jae Il Shin or Kee Hyuck Kim.

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Park, S.J., Oh, Y.S., Choi, M.J. et al. Hyponatremia may reflect severe inflammation in children with febrile urinary tract infection. Pediatr Nephrol 27, 2261–2267 (2012). https://doi.org/10.1007/s00467-012-2267-9

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  • DOI: https://doi.org/10.1007/s00467-012-2267-9

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