This document describes a case study of a two-month-old Cameroonian male infant who presented with acute kidney injury and sepsis due to an undiagnosed case of posterior urethral valves. The infant had a history of a treated urinary tract infection as a newborn. Ultrasound revealed uretero-hydronephrosis and a distended bladder, suggesting posterior urethral valves. The infant developed Klebsiella pneumoniae sepsis and acute kidney injury with uremia and hyperkalemia due to the delayed diagnosis of the valves. He underwent a vesicostomy and was scheduled for valve resection surgery but unfortunately died three days post-operation from refractory hyperkalemia and

1. A case of complicated acute kidney injury associated with a
severe sepsis in a Cameroonian child with posterior urethral
valves
Francky Teddy A. Endomba1*, A. Junette M. Metogo2, Joel NoutakdieTochie1, 2, Jan René Nkeck1, Jacqueline Ze Minkande2
1Specialized Internship Program, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
2Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Introduction: Pediatric post renal acute kidney injury is a
scarce, serious and avoidable condition. This is because
early warning signs of urinary tract malformations like
recurrent urinary tract infections, often warrant the realization
of diagnostic imaging studies for their timely diagnosis and
management (1,2). Herein, we present the case of a delayed
diagnosed posterior urethral valves (PUV) complicated by
acute kidney injury and septicemia in a Cameroonian infant.
Case presentation: A two-month-old male with past history
of a treated neonatal urinary tract infection, was transferred
to the intensive care unit for the pre-operative management
of a complicated posterior urethral valves. The diagnosis of
PUV was suggested by ultrasound (see figure 1) and as
complication, he had Klebsiella pneumoniae septicemia and
acute kidney injury (AKI) with uremic syndrome and
hyperkaliemia. He was treated by broad spectrum antibiotics
which were adapted following results of bacterial cultures,
kayexalate, salbutamol and other standard measures of
care. He underwent a vesicostomy to relief the urinary
obstruction prior to valvular surgical resection. We lost the
infant on day three post operation from severe refractory
hyperkaliemia and uremic syndrome.
Figure1: Uretero-hydronephrosis and distended bladder
Discussion: PUV is the most prevalent pediatric obstructive
uropathy and represents a preventable etiology of AKI (1).
Hence, current recommendations stipulate the realization of
imaging studies for all infants aged between two months and
two years having a febrile urinary tract infection, for a timely
diagnosis and management of urinary tract malformations
such as PUV (2). Tough the gold standard for the diagnosis
remains voiding cystourethrogram (VCUG), the initial
imaging is usually ultrasound with as “keyhole” sign, the
dilatation of the posterior urethra (3).
Conclusion: The above case draws clinicians’ attention on
the importance of timely requesting morphological
investigations when confronted with an infant presenting a
febrile urinary tract infection.
1. Gulati S. Acute kidney injury in children. Clinical Queries: Nephrology. 2012 Jan 1;1(1):103–8.
2. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection:
clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011
Sep;128(3):595–610.
3. Nasir AA, Ameh EA, Abdur-Rahman LO, Adeniran JO, Abraham MK. Posterior urethral valve. World J Pediatr. 2011 Aug;7(3):205–16.
Corresponding author email : tedissimo@yahoo.com