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World J Clin Pediatr. Aug 30, 2018; 7(3): 83-88
Published online Aug 30, 2018. doi: 10.5409/wjcp.v7.i3.83
Clinical features of acute kidney injury in patients with Kawasaki disease
Toru Watanabe
Toru Watanabe, Department of Pediatrics, Niigata City General Hospital, Niigata City 950-1197, Japan
Author contributions: Watanabe T solely contributed to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toru Watanabe, MD, PhD, Doctor, Department of Pediatrics, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, 950-1197, Japan. twata@hosp.niigata.niigata.jp
Telephone: +81-25-2815151 Fax: +81-25-2815169
Received: June 19, 2018
Peer-review started: June 20, 2018
First decision: June 19, 2018
Revised: August 1, 2018
Accepted: August 6, 2018
Article in press: August 7, 2018
Published online: August 30, 2018
Abstract

Although acute kidney injury (AKI) is a common complication in hospitalized children, AKI has rarely been reported in patients with Kawasaki disease (KD). Herein, we review the clinical trajectories of AKI in patients with KD. A total of 39 patients with KD who developed AKI have been reported in 28 publications as case reports. The causes of AKI include prerenal AKI associated with acute heart failure (AHF), intrinsic AKI caused by tubulointerstitial nephritis (TIN), acute nephritic syndrome (ANS), hemolytic uremic syndrome (HUS), immune complex-mediated nephropathy, rhabdomyolysis, and KD shock syndrome (KDSS). Six of the 39 patients (15.4%) underwent renal replacement therapy. While AHF and multiple organ dysfunction syndrome developed in 41% and 68% of KD patients with AKI, respectively, all patients recovered without any renal sequelae. Although the precise pathogenic mechanism underlying the development of AKI in patients with KD is unknown, several possible mechanisms have been proposed, including T-cell-mediated immunologic abnormalities for TIN, renal and glomerular endothelial injury resulting from vasculitis for HUS, immune complex-mediated kidney injury for immune complex-mediated nephropathy and ASN, and capillary leak and an increased release of cytokines with myocardial dysfunction for KDSS.

Keywords: Kawasaki disease, Acute kidney injury, Kidney involvement, Multiple organ dysfunction syndrome

Core tip: Acute kidney injury (AKI) has rarely been reported in patients with Kawasaki disease (KD). We review the clinical characteristics of AKI in patients with KD and show that AKI is caused by a number of pathologic changes induced by KD. Patients with KD and AKI had good outcomes, despite the developed of multiple organ dysfunction syndrome. The possible mechanisms underlying the development of AKI in KD include T-cell-mediated immunologic abnormalities, renal and glomerular endothelial injury resulted from vasculitis, immune complex-mediated kidney injury, and capillary leak and the increased release of cytokines with myocardial dysfunction.