Acute Renal Failure in Kawasaki Disease

Ardle, Brian Mc; Chambers, T L; Weller, S. D. V.; Tribe, C. R.

doi:10.1177/014107688307600718

Cited by 32 publications

(27 citation statements)

References 7 publications

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“…Our results are consistent with several reports of clinically significant renal impairment in KD [10][11][12][13][14]; renal pathology has also been described on both biopsy and postmortem examination. Histological findings included a normal glomerulus or mild expansion of the mesangial matrix; interstitial infiltration of lymphocytes, plasmocytes, and eosinophils; and a focus of tubular necrosis [12][13][14]27].…”

Section: Discussionsupporting

confidence: 93%

“…Histological findings included a normal glomerulus or mild expansion of the mesangial matrix; interstitial infiltration of lymphocytes, plasmocytes, and eosinophils; and a focus of tubular necrosis [12][13][14]27]. In a series of histopathological examinations from 25 patients who died of KD, four infants had significant renal vascular involvement, including panarteritis of the interlobar and smaller arteries, arteriolitis, phlebitis, thromboarteritis, and intimal proliferative occlusive arteritis [28].…”

Section: Discussionmentioning

confidence: 99%

“…The most common presentations are sterile pyuria and proteinuria; fewer patients have transient microscopic hematuria [2,3,8,9]. Although they are rare, severe complications such as renovascular hypertension, hemolytic uremic syndrome, interstitial nephritis, and acute renal failure have been reported [10][11][12][13][14]. Vascular involvement occurs in blood vessels of small and medium size, such as renal arteries; renal involvement is thus possible [15].…”

Section: Introductionmentioning

confidence: 99%

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Renal scarring sequelae in childhood Kawasaki disease

et al. 2007

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To assess renal inflammation and its sequelae in Kawasaki disease (KD) patients, we conducted a prospective study in a university medical center setting in Taiwan. From June 2002 to January 2005, 50 children with KD were enrolled, and after admission, all received technetium-99m dimercaptosuccinic acid scintigraphy single photon emission computed tomography (DMSA renal SPECT), the results of which were used as the reference standard for determining renal inflammation. Patients with renal inflammation underwent another DMSA renal SPECT more than 6 months later to evaluate the sequelae. We found that 26 of the 50 patients (52%) had renal inflammatory foci. There were no significant relationships between clinical or laboratory parameters and renal involvement in KD, except the presence of coronary artery lesions [P<0.01; odds ratio (OR) 5.18; 95% confidence interval (CI) 1.52-17.65]. Although all patients were free of clinical symptoms, the 6-month follow-up DMSA renal SPECT showed renal scarring in 11 of the 24 patients (46%). Patients with an initial abnormal renal ultrasound did predict a greatly increased risk of scarring (P<0.05; OR 16.2; 95% CI 1.27-206.20). In conclusion, this study demonstrated that the potential long-term clinical impact of KD is not limited to coronary artery lesion sequelae but also includes renal scar formation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal scarring sequelae in childhood Kawasaki disease

et al. 2007

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“…Although the renal involvement in KD is only transient and self-limited in most of the cases, progression into more severe renal damage is occasionally reported, such as continuous abnormal urinary findings, acute renal failure, nephrotic syndrome and haemolytic uraemic syndrome [4,8,14]. The urinary IL-6 levels could be clinically useful indicator for the monitoring of progression into more severe renal damage in acute KD.…”

Section: Resultsmentioning

confidence: 99%

Increased levels of urinary interleukin-6 in Kawasaki disease

et al. 1993

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Kawasaki disease (KD) often presents with abnormal urinary findings, such as aseptic pyuria, mild proteinuria and microscopic haematuria. In this study, we measured urinary interleukin-6 (IL-6) by a sensitive sandwich ELISA assay using mouse monoclonal antibodies against recombinant IL-6 to elucidate the role of IL-6 in the pathogenesis of renal lesions in KD. Serum IL-6 levels were increased in acute KD as well as in febrile controls. Importantly, urinary IL-6 levels were consistently elevated in patients with acute KD, but much lower in febrile controls. Urinary IL-6 levels returned steadily to normal during the convalescent phase. In addition to IL-6, urinary levels of N-acetyl-beta-D-glucosaminidase (NAG) and beta 2-microglobulin (beta 2-mg) were also elevated during the acute phase of this disease. Eosinophils and macrophages were identifiable in urinary sediments from these patients. The increased levels of urinary IL-6 in combination with increased NAG and beta 2-mg seemed to suggest the presence of certain renal parenchymal lesions with cellular infiltration during the acute phase of the disease. IL-6 may serve as clinically useful parameter for the detection and monitoring of the renal involvement in KD.

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“…Sterile pyuria and proteinuria are the most frequent features [10][11][12]. Acute renal failure with tubulointerstitial changes has been reported in a few patients [13][14][15][16]. Nephrotic syndrome may develop during the course of the disease with a spontaneous remission without steroid therapy [17].…”

Section: Kawasaki Disease (Kd)mentioning

confidence: 99%