Paraclinical Evolutions Regarding Liver and Renal Abnormalities of Kawasaki Disease in the Southeast of Iran

Abstract

Context: Hemolytic uremic syndrome (HUS), being more prevalent in infants and children, is recognized by a triad of acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. It is classified according to the underlying disorders, such as infection, systemic, metabolic disorder, or complement dysregulation. It has a high rate of morbidity and mortality. Many types of treatment, such as conservative management, plasma exchange, regular plasma infusion, and even a new expensive medication, "Ecluzimab", have been suggested. The aim of this systematic review is to estimate the incidence and prevalence of HUS (according to diarrhea positive or negative samples). In addition, the study will investigate the clinical presentation and the outcome of Iranian patients. Evidence Acquisition: The following data bases will be explored for articles published between years 1985 and 2016, PubMed, EM-BASE, OVID, SCOPUS, Web of Sciences, Google Scholar, Google, barakatkns.com, MagIran, SID, dociran, PDFiran, and ganj.irandoc. Besides, all online university databases will be searched for theses and abstracts of local or international congresses; a manual search will be performed to identify pertinent cross references. Systematic review or meta-analysis, longitudinal and cohort studies, crosssectional, case-control, and epidemiological studies will be included in this review. Relevant conference proceedings, theses or unpublished data will also be considered. The retrieved data should comprise of proportions, incidence, prevalence, geographical distribution, mortality and morbidity rates (i.e. dialysis and central nervous system involvement). A meta-analysis will be performed if 3 similar studies are found. If sufficient data is extracted, subgroup analysis will be performed for age, gender, acute kidney injury, dialysis, and death. Results:The results of the current study could have implications for health policies, practice, research, and medical education: The data could improve clinical and health care decisions, allow estimation of the number of patients that require new medication, and could direct future research design in this field.

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

“…A study has reported that 37% of the patients with KD had a significant rise in the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) while 41% of them had an elevated gamma-glutamyl transferase (GGT) level [105]. Similarly, another study also reported that most children with KD had impaired LFT with raised ALT and/or AST [106]. In a retrospective review that scrutinised the liver function profile among 210 KD children, hypoalbuminemia was prevalent along with high AST and low total protein during the acute KD period [17].…”

Kawasaki Disease: Paraclinical Evolution and Clinical Outcomes of Iranian Patients

“…In the Sedighi et al study, the percentage of pyuria was 20.2% and the difference from the usual frequency, which is usually found in 33-63% of patients, might be explained by the fact that pyuria is a transient symptom and urine analysis should be repeated in suspected patients (2)(3)(4).…”

“…Diagnosis is based on clinical criteria mostly from the affected skin and mucosa (1). It was very interesting that Sedighi et al and Soleimani et al in their recent publications in the Journal of Comprehensive Pediatrics revealed the clinical characteristics of Kawasaki disease, and the liver and renal paraclinical abnormalities, respectively, of this condition in the Iranian population (2,3).…”

Changing Management of Kawasaki Disease

“…In patients presenting with febrile cholestatic jaundice, a high index of suspicion to KD should always be maintained (10). Soleimani et al also reported hydrops of gallbladder in 12.7% of the enrolled patients (8). Abnormal gallbladder findings were significantly more frequent in children who developed CAA (11); but, further studies are needed to clarify whether patients with hydrops of gallbladder may require a more aggressive therapy, for example corticosteroids.…”

“…Recently, two studies evaluated the clinical and biochemical characteristics of KD in Iranian children (8,9). Soleimani et al reported a significant prevalence of liver abnormalities (46.8%), ranging from mild asymptomatic increase in the liver enzymes to severe cholestatic hepatitis (8). In patients presenting with febrile cholestatic jaundice, a high index of suspicion to KD should always be maintained (10).…”