Secondary or Transient Pseudohypoaldosteronism Associated With Urinary Tract Anomaly and Urinary Infection: A Case Report.

Hyponatremia with hyperkalemia in infancy is a rare presentation, but may be due to aldosterone deficiency or end organ resistance to its action. There are few cases associating this condition with urinary tract infections or anatomic abnormalities that predispose to infection. Clinicians should have a high index of suspicion in diagnosing secondary pseudohypoaldosteronism (PHA) due to its often atypical presentation. We describe ten month-old infant who presented with this condition and was found to have urinary tract infection complicating unilateral urinary tract anomaly, which may have strong association with renal tubular resistance to aldosterone.

Associations between structural and functional changes to the kidney in diabetic humans and mice.

Type 1 and Type 2 diabetic patients are at high risk of developing diabetic nephropathy (DN). Renal functional decline is gradual and there is high variability between patients, though the reason for the variability is unknown. Enough diabetic patients progress to end stage renal disease to make diabetes the leading cause of renal failure. The first symptoms of DN do not appear for years or decades after the onset of diabetes. During and after the asymptomatic period structural changes develop in the diabetic kidney. Typically, but not always, the first symptom of DN is albuminuria. Loss of renal filtration rate develops later. This review examines the structural abnormalities of diabetic kidneys that are associated with and possibly the basis for advancing albuminuria and declining GFR. Mouse models of diabetes and genetic manipulations of these models have become central to research into mechanisms underlying DN. This article also looks at the value of these mouse models to understanding human DN as well as potential pitfalls in translating the mouse results to humans.

Hypertension and a missing kidney.

Standard initial assessment via ultrasound of a 4-year-old girl with hypertension revealed the absence of one kidney. Instead of cross-sectional imaging of the retroperitoneal space, a functional (nuclear) study was performed. This revealed a malformed kidney within the chest. Though systemic levels of renin and aldosterone were not elevated, removal of the malformed kidney normalized the blood pressure. The presence of prominent smooth muscle nodules surrounding the arteries was seen in the malformed kidney. Initial attempts to avert surgery by pharmacologically reducing blood flow to the malformed kidney were unsuccessful. The review of the literature offers little evidence to support such a strategy.

Dextroamphetamine use during B-2 combat missions.

INTRODUCTION: Fatigue among warriors can jeopardize mission success. Prescribed stimulant medications, in-flight sleep, and self-medication with caffeine can mitigate fatigue. During Operation Iraqi Freedom, pilots flew the B-2 bomber to targets in Iraq from one of two airfields. Sortie durations were long (16.9 h) from one field and very long (35.3 h) from the other. Controversy exists concerning the use of stimulant medication, in part because of a paucity of combat data. METHODS: A retrospective analysis of 75 pilots who performed 94 combat sorties was performed. We examined the prevalence of the pilot's decision to use dextroamphetamine, caffeine, and in-flight sleep during combat. We compared demographic factors, the impact of one anti-fatigue tool on the use of others, stimulant benefit, and adverse effects. RESULTS: Pilots on shorter missions used dextroamphetamine for 97% and in-flight naps for 13% of sorties. Those on longer missions used dextroamphetamine on 58% and naps on 94% of sorties. Stimulant use was not affected by pilot age, bomber experience, or long-duration experience. The opportunity to obtain in-flight sleep was limited by certain mission profiles, which influenced the decision to use dextroamphetamine. Among pilots who used the medication, 97% noted a benefit. Side effects and failure to observe benefits were uncommon. CONCLUSIONS: B-2 pilots in long-duration combat flight selectively employ dextroamphetamine, naps, and other fatigue countermeasures. Major determinants of these decisions are mission requirements and the pilot's experience with each measure and its effect.