Pediatr Infect Vaccine.  2017 Aug;24(2):112-116. 10.14776/piv.2017.24.2.112.

Kawasaki Disease Shock Syndrome with Acute Kidney Injury and Hypertension

• Choi JH
• Kim YJ
• Kim YD
• Han KH

• KMID: 2401453
• DOI: http://doi.org/10.14776/piv.2017.24.2.112

Abstract

Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome that commonly presents with stable hemodynamic status during the acute phase. An 8-year-old boy initially presented with severe hypotension and acute kidney injury. He was placed in the intensive care unit and was diagnosed with KD. Observed clinical features were defined as KD shock syndrome. His coronary artery was dilated during the subacute phase. Furthermore, he was given anti-hypertensive medications, owing to hypertension as an unusual complication of KD. We knew the importance of monitoring for blood pressure considering vasculitis as an aspect of the main pathogenesis of KD.

Keyword

Mucocutaneous lymph node syndrome; Shock; Acute kidney injury; Hypertension

MeSH Terms

Acute Kidney Injury*
Blood Pressure
Child
Coronary Vessels
Hemodynamics
Humans
Hypertension*
Hypotension
Intensive Care Units
Male
Mucocutaneous Lymph Node Syndrome*
Shock*
Vasculitis

Figure

• 

  Fig. 1 A 24-hour ambulatory blood pressure monitoring 19 days after disease onset.

• 

  Fig. 2 Changes in the estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) related to the hospital day (HD). *eGFRs were calculated using the creatinine-based “Bedside Schwartz” equation.

Reference

1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967; 16:178–222.

2. Mandal S, Pande A, Mandal D, Sarkar A, Kahali D, Panja M. Various coronary artery complications of Kawasaki disease: Series of 5 cases and review of literature. J Cardiovasc Dis Res. 2012; 3:231–235.

3. Titze U, Janka G, Schneider EM, Prall F, Haffner D, Classen CF. Hemophagocytic lymphohistiocytosis and Kawasaki disease: combined manifestation and differential diagnosis. Pediatr Blood Cancer. 2009; 53:493–495.

4. Gatterre P, Oualha M, Dupic L, Iserin F, Bodemer C, Lesage F, et al. Kawasaki disease: an unexpected etiology of shock and multiple organ dysfunction syndrome. Intensive Care Med. 2012; 38:872–878.

5. Harada T, Ito S, Shiga K, Inaba A, Machida H, Aihara Y, et al. A report of two cases of Kawasaki disease treated with plasma exchange. Ther Apher Dial. 2008; 12:176–179.

6. Thabet F, Bafaqih H, Al-Mohaimeed S, Al-Hilali M, Al-Sewairi W, Chehab M. Shock: an unusual presentation of Kawasaki disease. Eur J Pediatr. 2011; 170:941–943.

7. Kanegaye JT, Wilder MS, Molkara D, Frazer JR, Pancheri J, Tremoulet AH, et al. Recognition of a Kawasaki disease shock syndrome. Pediatrics. 2009; 123:e783–e789.

8. Chen PS, Chi H, Huang FY, Peng CC, Chen MR, Chiu NC. Clinical manifestations of Kawasaki disease shock syndrome: a case-control study. J Microbiol Immunol Infect. 2015; 48:43–50.

9. Dominguez SR, Friedman K, Seewald R, Anderson MS, Willis L, Glode MP. Kawasaki disease in a pediatric intensive care unit: a case-control study. Pediatrics. 2008; 122:e786–e790.

10. Kim KY, Kim DS. Recent advances in Kawasaki disease. Yonsei Med J. 2016; 57:15–21.

11. Burns JC. Kawasaki disease. Adv Pediatr. 2001; 48:157–177.

12. Watanabe T. Kidney and urinary tract involvement in kawasaki disease. Int J Pediatr. 2013; 2013:831834.

13. Mac Ardle BM, Chambers TL, Weller SD, Tribe CR. Acute renal failure in Kawasaki disease. J R Soc Med. 1983; 76:615–616.

14. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016; 34:1887–1920.

15. Hu P, Wang J, Fan XC, Hu B, Lu L. Hypertension triggers the rupture of coronary artery aneurysm in an 8-year-old boy with Kawasaki disease. J Clin Hypertens (Greenwich). 2014; 16:766–767.

16. Takahashi K, Oharaseki T, Yokouchi Y, Hiruta N, Naoe S. Kawasaki disease as a systemic vasculitis in childhood. Ann Vasc Dis. 2010; 3:173–181.

17. Papadodima SA, Sakelliadis EI, Goutas ND, Vlachodimitropoulos DG, Spiliopoulou CA. Atypical kawasaki disease presenting with symptoms from the genitourinary system: an autopsy report. J Trop Pediatr. 2009; 55:55–57.

18. Foster BJ, Bernard C, Drummond KN. Kawasaki disease complicated by renal artery stenosis. Arch Dis Child. 2000; 83:253–255.

19. Nagao M, Yamamoto K, Urabe T, Amakawa R, Ito A, Aosima S, et al. Percutaneous transluminal renal artery angioplasty in a 3-year-old hypertensive boy. Kokyu To Junkan. 1986; 34:1227–1230.

20. Kissel M, Phoon CK, Kahn PJ. Hypertension during intravenous immune globulin infusion for Kawasaki's disease: an underreported phenomenon? Clin Pediatr (Phila). 2015; 54:491–491.