Secondary pseudohypoaldosteronism causing cardiopulmonary arrest and cholelithiasis

A 4-month-old boy presented with cardiopulmonary arrest on arrival after a brief period of lethargy. Laboratory examination indicated severe hyperkalemia, hyponatremia, metabolic acidosis, and slightly elevated C-reactive protein. Whole body computed tomography identified left-dominant hydronephrosis, hydroureter and cholelithiasis. Despite cardiac arrest >30 min, he was successfully resuscitated and treated with therapeutic hypothermia. Escherichia coli was detected on urine culture. Renal ultrasound showed bilateral hydronephrosis, grade II in the right and grade IV in the left. Retrospective analysis of the blood sample at admission indicated a high level of aldosterone. The patient recovered almost fully with no electrolyte imbalance and normal plasma renin and aldosterone, leading to the diagnosis of secondary pseudohypoaldosteronism associated with bilateral infected hydronephrosis. In this case, cholelithiasis, which may account for chronic dehydration, was a diagnostic clue in the absence of information of pre-existing situations.