From the Department of Pediatrics, US Naval Hospital, Guam.
A FULL-TERM, male infant presented at 4 days of life with decreased urine output, fever, and poor feeding. Delivery was complicated by a shoulder dystocia, and the infant had required a brief period of continuous positive airway pressure ventilation for apnea and central cyanosis. The infant was discharged from the hospital at 48 hours of life, following an uneventful postnatal course.
On initial presentation, blood, urine, and cerebrospinal fluid cultures were obtained. A urinalysis revealed microscopic hematuria and proteinuria. Further laboratory evaluation was notable for the following levels: serum sodium,155 mmol/L; serum urea nitrogen, 21.8 mmol/L (7.8 mg/dL); serum creatinine, 424.3 µmol/L (4.8 mg/dL); fractional excretion of sodium, 4.6%; and serum uric acid, 1118.2 mmol/L. Results of a complete blood cell count were normal.
A renal sonogram was obtained (Figure 1). The infant's kidney function normalized (on the third day of hospitalization) with fluid restriction and diuretic therapy. Laboratory studies revealed a serum creatinine level of 44.2 µmol/L (0.5 mg/dL) and a serum uric acid level of 285.5 mmol/L. Results of a renal sonogram at 2 months of age were normal.
Radiological Case of the Month. Arch Pediatr Adolesc Med. 1999;153(4):423-424. doi: