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

 Se Jin Park  ;  Yoon Soo Oh  ;  Min Jeong Choi  ;  Jae Il Shin  ;  Kee Hyuck Kim 
 PEDIATRIC NEPHROLOGY, Vol.27(12) : 2261-2267, 2012 
Journal Title
Issue Date
Child, Preschool ; Female ; Fever/complications ; Humans ; Hyponatremia/complications* ; Hyponatremia/epidemiology ; Incidence ; Infant ; Inflammation/complications* ; Inflammation/diagnostic imaging ; Kidney/diagnostic imaging ; Kidney Function Tests ; Male ; Radionuclide Imaging ; Radiopharmaceuticals ; Retrospective Studies ; Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections/complications* ; Urinary Tract Infections/diagnostic imaging
Urinary tract infection ; Hyponatremia ; Inflammation ; 99m Tc-dimercaptosuccinic acid scintigraphy
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, (99m)Technetium-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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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
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