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Hyponatremia May Reflect Severe Inflammation in Children with Kawasaki Disease

  • Lee, I Re (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Park, Se Jin (Department of Pediatrics, Ajou University School of Medicine, Daewoo General Hospital) ;
  • Oh, Ji Young (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Jang, Gwang Cheon (Departments of Pediatrics, National Health Insurance System Ilsan Hospital) ;
  • Kim, Uria (Departments of Pediatrics, National Health Insurance System Ilsan Hospital) ;
  • Shin, Jae Il (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Kee Hyuck (Departments of Pediatrics, National Health Insurance System Ilsan Hospital)
  • Received : 2015.09.20
  • Accepted : 2015.10.25
  • Published : 2015.10.30

Abstract

Purpose: The aim of the present study was to investigate the risk factors for the development of coronary artery lesions (CALs) and to determine whether hyponatremia is associated with CALs in children with Kawasaki disease (KD). Methods: We retrospectively analyzed the data of 105 children with KD who were admitted to Ilsan Hospital between January 2000 and July 2011. Results: Erythrocyte sedimentation rate (P = 0.013), total bilirubin levels (P = 0.017) were higher and serum sodium levels (P = 0.027) were lower in KD children with CALs than those without. White blood cell (WBC) counts (P = 0.006), neutrophil counts (P = 0.003) were higher and albumin levels (P = 0.009) were lower in KD children with hyponatremia than those without. On multiple logistic regression analysis, hyponatremia (P = 0.024) and intravenous immunoglobulin-resistance (P = 0.024) were independent risk factors for CALs in KD. Furthermore, serum sodium levels were correlated negatively with WBC counts (P = 0.004), neutrophil counts (P < 0.001), total bilirubin levels (P = 0.005) and positively with albumin levels (P = 0.009). Conclusion: Our study indicates that hyponatremia may reflect severe inflammation in children with KD.

Keywords

References

  1. Burns JC, Glode MP. Kawasaki syndrome. Lancet 2004;364:533-44. https://doi.org/10.1016/S0140-6736(04)16814-1
  2. Burns JC. Kawasaki disease. Adv Pediatr 2001;48:157-77.
  3. Chen J, Liu Y, Liu W, Wu Z. A meta-analysis of the biomarkers associated with coronary artery lesions secondary to Kawasaki disease in Chinese children. J Huazhong Univ Sci Technolog Med Sci 2011;31:705-11. https://doi.org/10.1007/s11596-011-0587-9
  4. Kuwabara M, Yashiro M, Kotani K, Tsuboi S, Ae R, Nakamura Y, et al. Cardiac lesions and initial laboratory data in Kawasaki disease: a nationwide survey in Japan. J Epidemiol 2015;25:189-93. https://doi.org/10.2188/jea.JE20140128
  5. Laxer RM, Petty RE. Hyponatremia in Kawasaki disease. Pediatrics 1982;70:655.
  6. Watanabe T, Abe Y, Sato S, Uehara Y, Ikeno K, Abe T. Hyponatremia in Kawasaki disease. Pediatr Nephrol 2006;21:778-81. https://doi.org/10.1007/s00467-006-0086-6
  7. Lim GW, Lee M, Kim HS, Hong YM, Sohn S. Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion in kawasaki disease. Korean Circ J 2010;40:507-13. https://doi.org/10.4070/kcj.2010.40.10.507
  8. Mori J, Miura M, Shiro H, Fujioka K, Kohri T, Hasegawa T. Syndrome of inappropriate anti-diuretic hormone in Kawasaki disease. Pediatr Int 2011;53:354-7. https://doi.org/10.1111/j.1442-200X.2010.03264.x
  9. Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004;46:33-8. https://doi.org/10.1111/j.1442-200X.2004.01840.x
  10. Arjunan K, Daniels SR, Meyer RA, Schwartz DC, Barron H, Kaplan S. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study. J Am Coll Cardiol 1986;8:1119-24. https://doi.org/10.1016/S0735-1097(86)80390-4
  11. Takahashi M, Mason W, Lewis AB. Regression of coronary aneurysms in patients with Kawasaki syndrome. Circulation 1987;75:387-94. https://doi.org/10.1161/01.CIR.75.2.387
  12. Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  13. Yi DY, Kim JY, Choi EY, Choi JY, Yang HR. Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children. BMC Pediatr 2014;14:51. https://doi.org/10.1186/1471-2431-14-51
  14. Eladawy M, Dominguez SR, Anderson MS, Glode MP. Abnormal liver panel in acute kawasaki disease. Pediatr Infect Dis J 2011;30:141-4. https://doi.org/10.1097/INF.0b013e3181f6fe2a
  15. Davies S, Sutton N, Blackstock S, Gormley S, Hoggart CJ, Levin M, et al. Predicting IVIG resistance in UK Kawasaki disease. 2015;100:366-8. https://doi.org/10.1136/archdischild-2014-307397
  16. Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007;166:131-7.
  17. Shin JI, Kim JH, Lee JS, Kim DS, Choi JY, Sul JH. Kawasaki disease and hyponatremia. Pediatr Nephrol 2006;21:1490-1; author reply 2. https://doi.org/10.1007/s00467-006-0242-z
  18. Mastorakos G, Weber JS, Magiakou MA, Gunn H, Chrousos GP. Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrinol Metab 1994;79:934-9.
  19. Eisenhut M. Changes in renal sodium transport during a systemic inflammatory response. Pediatr Nephrol 2006;21:1487-8; author reply 9. https://doi.org/10.1007/s00467-006-0199-y
  20. Maruyama K, Watanabe H, Onigata K. Reversible secondary pseudohypoaldosteronism due to pyelonephritis. Pediatr Nephrol 2002;17:1069-70. https://doi.org/10.1007/s00467-002-0993-0
  21. Watanabe T. Kidney and urinary tract involvement in kawasaki disease. Int J Pediatr 2013;2013:831834.
  22. Lin KH, Chang SS, Yu CW, Lin SC, Liu SC, Chao HY, et al. Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis. 2015;5:e006703. https://doi.org/10.1136/bmjopen-2014-006703
  23. Iwashima S, Ishikawa T. B-type natriuretic peptide and N-terminal pro-BNP in the acute phase of Kawasaki disease. World J Pediatr 2013;9:239-44. https://doi.org/10.1007/s12519-013-0402-8