Salt Losing Obstructive Uropathy with Paradoxically Low Urinary Sodium Concentration: Salt Entrapment in an Obstructed Ectopic Ureterocele

A 6-month-old hyponatremic female with failure to thrive had low urinary sodium concentration. Renal sonography revealed a duplex left collecting system with obstruction of the upper moiety as a blind-ended ectopic ureterocele extending to the bladder base. The echogenicity of the urine within the upper pole system was greater than the bladder contents. We believed that low urinary sodium concentration represented a false negative test and the salt loss by the obstructed left kidney was entrapped in the upper pole collecting system. Prior to ureterocele repair, intraoperative bladder and ureterocele aspirates revealed discordant sodium concentration supporting the sonographic conclusion.