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Kim, Lee, Choi, and Lee: Clinical Features of Kawasaki Disease with Pyuria
Original Article

Pediatr Infect Vaccine 2017;24(3):141-145.

Published online: 21 January 2017

DOI: https://doi.org/10.14776/piv.2017.24.3.141

Clinical Features of Kawasaki Disease with Pyuria

Hyo-Jin Kim, Joo-Young Lee, Ui-Yoon Choi, Soo-Young Lee

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, the Republic of Korea

Received 9 May 20178 June 2017       Accepted 7 August 2017

Copyright © 2017 The Korean Society of Pediatric Infectious Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. Methods: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retrospectively analyzed.

Results

Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD.

Conclusions

KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.

Keywords: Mucocutaneous lymph node syndrome, Pyuria, Fever, Child

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Table 1.
Characteristics and Clinical Outcomes of Children with Kawasaki Disease
Variable KD with pyuria (n=48) KD without pyuria (n=92) P-value
Male 33 (68.8) 53 (57.6) 0.199
Age (mo) 23.0 (9.0-33.8) 22.5 (11.0-37.0) 0.495
Duration of fever before Starting IVIG (day) 5.0 (4.0-5.0) 5.0 (4.0-5.0) 0.643
Length of hospital stay (day) 6.0 (5.0-7.0) 5.0 (4.0-6.0) 0.087
Incomplete KD 11 (22.9) 23 (25.0) 0.785
Unresponsiveness to 1st IVIG therapy 10 (20.8) 12 (13.0) 0.229
Develpomenet of CALs 8 (16.7) 8 (8.7) 0.159
Renal image study 6 (12.5) 0 0.001
Anytibiotic usage 32 (66.7) 44 (47.8) 0.034

Values are presented as number (%) or median (interquartile range). Abbreviations: KD, Kawasaki disease; IVIG, intravenous immunoglobulin; CA1

Table 2.
Blood and Urine Tests of Children with Kawasaki Disease
Variable KD with pyuria (n=48) KD without pyuria (n=92) P-value
WBC count (x109/L) 14.7(11.1-18.6) 13.9 (10.8-17.8) 0.365
Absolute neutrophil count (X109/L) 9.1 (7.7-12.5) 8.4 (6.1-12.7) 0.273
Hemog|obin (g/dL) 11.3 (10.6-12.2) 11.4 (10.9-12.0) 0.839
Platelet count (x109/L) 357 (2927-426) 345 (286-428) 0.860
ESR (mm/hr) 54 (41-70) 55 (39-67) 0.831
CRP (mg/L, normal <0.5) 9.4 (5.8-12.1) 5.4 (5.0-10.0) 0.007
Serum Na (mEq/L) 136 (135-137) 136 (135-137) 0.941
Albumin (g/dL) 3.9 (3.7-4.1) 4.0 (3.7-4.2) 0.420
AST (IU/L) 52 (40-193) 37 (27-66) 0.017
ALT (IU/L) 109 (30-258) 21 (14-70) 0.084
Elevated AST (>40 |U/L) 34 (70.8) 39 (42.4) 0.001
Elevated ALT (>40 IU/L) 34 (70.8) 28 (30.4) 0.001
Presence of hematuria 10 (20.8) 3 (3.3) 0.001
Presence of proteinuria 7 (14.6) 3 (3.3) 0.014

Values are presented as median (interquartile range) or number (%). Abbreviations: KD, Kawasaki disease; WBC, white blood cell; ESR, erythrocyte; edimentation rate; CRP, C-reactive protein; AST, aspartate aminotransferase;

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