Aldosteronuria and the Edema of Kwashiorkor

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Abstract
Multiple urinary aldosterone estimations were made on twelve children suffering from kwashiorkor and one from marasmus. A standard of comparison was supplied by estimations made on thirteen normal children. The values for urinary aldosterone found in these normal children (average age three and one-half years) were: mean 2.2 µg. per twenty-four hours; range 0.5 to 5 µg. per twenty-four hours. The patients were tested during the edematous phase, during diuresis and during later convalescence. In five cases frequent aldosterone estimations were correlated with the result of full sodium and potassium balance studies. The effect of ACTH was observed in two cases. Hyperaldosteronuria coincided with edema in only six of the twelve cases of kwashiorkor, and even in these the evidence did not suggest a causal relationship. In other cases no aldosterone at all was found at the height of the edema, or during the period of sodium retention. A high urinary aldosterone level was most commonly related to the period of sodium diuresis. These rather unexpected results led us to believe that mechanisms other than that of aldosterone excretion are responsible for the sodium retention in kwashiorkor although the many factors which may alter urinary aldosterone levels complicate the assessment of the role played by this steroid.