Skip to main content

Advertisement

SpringerLink
Log in

Nephrotic syndrome in Kawasaki disease: a report of three cases

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Renal manifestations are rare in Kawasaki disease (KD). Acute renal failure with tubular necrosis, tubulointerstitial nephritis and renovascular hypertension have been reported in KD, but only one case of a patient with KD associated with nephrotic syndrome (NS) has been reported to date, with the patient improving on steroid therapy but dying from coronary aneurysm.

Methods

We report the cases of three children, aged 4, 4.5 and 8 years, respectively, who presented with typical KD symptoms (high fever, diffuse maculopapular rash, conjunctivitis, peripheral oedema, cervical adenopathies and high C reactive protein levels) and developed NS.

Results

Patient 1 had a haemodynamic shock due to cardiac dysfunction and transient renal failure. Ten days later, he developed a NS which spontaneously disappeared 1 week later. Patient 2 had a NS on admission with normal plasma creatinine and no haematuria. Proteinuria disappeared within 10 days. Patient 3 developed NS 5 days after onset with a moderate increase in plasma creatinine. Proteinuria disappeared within 2 weeks. All three patients were treated with intravenous immunoglobulins, antibiotic therapy and aspirin, but none of them received steroid therapy. To date, all three patients have maintained long-term remission.

Conclusions

In conclusion, proteinuria with NS may develop during the acute phase of KD with persistent remission occurring without steroid therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

    PubMed  CAS  Google Scholar 

  2. Brogan PA, Bose A, Burgner D, Shingadia D, Tulloh R, Michie C, Klein N, Booy R, Levin M, Dillon MJ (2002) Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 86:286–290

    Article  PubMed  CAS  Google Scholar 

  3. Burns JC, Glode MP (2004) Kawasaki syndrome. Lancet 364:533–544

    Article  PubMed  Google Scholar 

  4. Rowley AH, Shulman ST, Spike BT, Mask CA, Baker SC (2001) Oligoclonal IgA response in the vascular wall in acute Kawasaki disease. J Immunol 166:1334–1343

    PubMed  CAS  Google Scholar 

  5. Lee BW, Yap HK, Yip WC, Giam YC, Tay JS (1989) Nephrotic syndrome in Kawasaki disease. Aust Paediatr J 25:241–242

    PubMed  CAS  Google Scholar 

  6. Nardi PM, Haller JO, Friedman AP, Slovis TL, Schaffer RM (1985) Renal manifestations of Kawasaki's disease. Pediatr Radiol 15:116–118

    Article  PubMed  CAS  Google Scholar 

  7. Watanabe T, Abe Y, Sato S, Uehara Y, Ikeno K, Abe T (2007) Sterile pyuria in patients with Kawasaki disease originates from both the urethra and the kidney. Pediatr Nephrol 22:987–991

    Article  PubMed  Google Scholar 

  8. Sevin C, Heidet L, Gagnadoux MF, Cheron G, Niaudet P (1993) Acute renal insufficiency in Kawasaki disease. Arch Fr Pediatr 50:505–507

    PubMed  CAS  Google Scholar 

  9. MacArdle BM, Chambers TL, Weller SD, Tribe CR (1983) Acute renal failure in Kawasaki disease. J R Soc Med 76:615–616

    CAS  Google Scholar 

  10. Bonany PJ, Bilkis MD, Gallo G, Lago N, Dennehy MV, Sosa del Valle JM, Vallejo G, Canepa C (2002) Acute renal failure in typical Kawasaki disease. Pediatr Nephrol 17:329–331

    Article  PubMed  Google Scholar 

  11. Ferriero DM, Wolfsdorf JI (1981) Hemolytic uremic syndrome associated with Kawasaki disease. Pediatrics 68:405–406

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Veiga PA, Pieroni D, Baier W, Feld LG (1992) Association of Kawasaki disease and interstitial nephritis. Pediatr Nephrol 6:421–423

    Article  PubMed  CAS  Google Scholar 

  14. Joh K, Kanetsuna Y, Ishikawa Y, Aizawa S, Naito I, Sado Y (1997) Diffuse mesangial sclerosis associated with Kawasaki disease: an analysis of alpha chains (alpha 1-alpha 6) of human type IV collagen in the renal basement membrane. Virchows Arch 430:489–494

    Article  PubMed  CAS  Google Scholar 

  15. Wang JN, Chiou YY, Chiu NT, Chen MJ, Lee BF, Wu JM (2007) Renal scarring sequelae in childhood Kawasaki disease. Pediatr Nephrol 22:684–689

    Article  PubMed  Google Scholar 

  16. Ohtomo Y, Kawamura R, Kaneko K, Yamashiro Y, Kiyokawa N, Taguchi T, Mimori K, Fujimoto J (2003) Nephrotic syndrome associated with human parvovirus B19 infection. Pediatr Nephrol 18:280–282

    PubMed  Google Scholar 

  17. Wierenga KJ, Pattison JR, Brink N, Griffiths M, Miller M, Shah DJ, Williams W, Serjeant BE, Serjeant GR (1995) Glomerulonephritis after human parvovirus infection in homozygous sickle-cell disease. Lancet 346:475–476

    Article  PubMed  CAS  Google Scholar 

  18. di Belgiojoso GB, Ferrario F, Landriani N (2002) Virus-related glomerular diseases: histological and clinical aspects. J Nephrol 15:469–479

    PubMed  Google Scholar 

  19. Lai AS, Lai KN (2006) Viral nephropathy. Nat Clin Pract Nephrol 2:254–262

    Article  PubMed  Google Scholar 

  20. Audard V, Lang P, Sahali D (2008) Minimal change nephrotic syndrome: new insights into disease pathogenesis. Med Sci (Paris) 24:853–858

    Article  Google Scholar 

  21. Le Berre L, Herve C, Buzelin F, Usal C, Soulillou JP, Dantal J (2005) Renal macrophage activation and Th2 polarization precedes the development of nephrotic syndrome in Buffalo/Mna rats. Kidney Int 68:2079–2090

    Article  PubMed  Google Scholar 

  22. Bourrillon A (2008) Kawasaki's disease: multiple and various aspects. Arch Pediatr 15:825–828

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Necker Hospital, Paris, France

    Pauline Krug, Olivia Boyer, Eve Balzamo & Patrick Niaudet

  2. Pediatric Cardiology, Necker Hospital, Paris, France

    Daniel Sidi

  3. Pediatrics, Montargis Hospital, Montargis, France

    Agnès Lehnert

Authors
  1. Pauline Krug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olivia Boyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eve Balzamo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Sidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Agnès Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Niaudet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Niaudet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krug, P., Boyer, O., Balzamo, E. et al. Nephrotic syndrome in Kawasaki disease: a report of three cases. Pediatr Nephrol 27, 1547–1550 (2012). https://doi.org/10.1007/s00467-012-2172-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-012-2172-2

Keywords

Search

Navigation