Is Pyuria With Kawasaki Disease Always Sterile?

Wu, Meng‐Che; Jan, Sheng-Ling; Lin, Ming-Chi; Fu, Yun‐Ching; Lin, Shing‐Jong

doi:10.1097/inf.0b013e31818b0e0c

Cited by 6 publications

(9 citation statements)

References 6 publications

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“…Shiono et al [ 25 ] reported a KD patient with a left vesicoureteral reflux associated with pyuria and pyelonephritis due to Escherichia coli . Wu et al [ 26 ] reported that 8 of 75 patients with KD had bacterial pyuria, while Benseler et al [ 27 ] reported that 42 of 129 (33%) patients with KD had ≥1 confirmed bacterial or viral infection at diagnosis, with 4 (3%) of these patients having a urinary tract infection (UTI). No difference in clinical phenotype or coronary artery outcome was observed in patients with a UTI compared with those without a UTI [ 26 , 27 ].…”

Section: Pyuriamentioning

confidence: 99%

“…Wu et al [ 26 ] reported that 8 of 75 patients with KD had bacterial pyuria, while Benseler et al [ 27 ] reported that 42 of 129 (33%) patients with KD had ≥1 confirmed bacterial or viral infection at diagnosis, with 4 (3%) of these patients having a urinary tract infection (UTI). No difference in clinical phenotype or coronary artery outcome was observed in patients with a UTI compared with those without a UTI [ 26 , 27 ]. It remains unclear whether bacterial UTI induces an immune response in patients with KD or whether this occurs only when the patients have a coexisting infection [ 26 ].…”

Section: Pyuriamentioning

confidence: 99%

“…No difference in clinical phenotype or coronary artery outcome was observed in patients with a UTI compared with those without a UTI [ 26 , 27 ]. It remains unclear whether bacterial UTI induces an immune response in patients with KD or whether this occurs only when the patients have a coexisting infection [ 26 ]. However, because the immune system is thought to be activated by an infectious trigger in genetically susceptible hosts with KD [ 5 ], a UTI may induce clinical features typical of KD.…”

Section: Pyuriamentioning

confidence: 99%

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Kidney and Urinary Tract Involvement in Kawasaki Disease

Watanabe

2013

International Journal of Pediatrics

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Kawasaki disease (KD) is a systemic vasculitis and can develop multiple organ injuries including kidney and urinary tract involvement. These disorders include pyuria, prerenal acute kidney injury (AKI), renal AKI caused by tubulointerstitial nephritis (TIN), hemolytic uremic syndrome (HUS), and immune-complex mediated nephropathy, renal AKI associated with either Kawasaki disease shock syndrome or unknown causes, acute nephritic syndrome (ANS), nephrotic syndrome (NS), renal tubular abnormalities, renal abnormalities in imaging studies, and renal artery lesions (aneurysms and stenosis). Pyuria is common in KD and originates from the urethra and/or the kidney. TIN with AKI and renal tubular abnormalities probably result from renal parenchymal inflammation caused by T-cell activation. HUS and renal artery lesions are caused by vascular endothelial injuries resulting from vasculitis. Some patients with ANS have immunological abnormalities associated with immune-complex formation. Nephromegaly and renal parenchymal inflammatory foci are detected frequently in patients with KD by renal ultrasonography and renal scintigraphy, respectively. Although the precise pathogenesis of KD is not completely understood, renal vasculitis, immune-complex mediated kidney injuries, or T-cell immune-regulatory abnormalities have been proposed as possible mechanisms for the development of kidney and urinary tract injuries.

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Section: Pyuriamentioning

confidence: 99%

Section: Pyuriamentioning

confidence: 99%

Section: Pyuriamentioning

confidence: 99%

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Kidney and Urinary Tract Involvement in Kawasaki Disease

Watanabe

2013

International Journal of Pediatrics

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“…Similarly, in the present study, two-thirds of the KD with pyuria group received antibiotics, because the clinical and laboratory findings at the initial stage did not meet the diagnostic criteria for KD but suggested UTI. Considering the epidemiologic prevalence of UTI, febrile children with pyuria and CRP elevation require empiric antibiotics and proper work-up for UTI [ 14 , 17 ]. However, when children suspected of having UTI show persistent fever despite proper antibiotic therapy, KD should be one of the differential diagnoses [ 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pyuria in most children with KD is sterile and accompanied by a negative nitrite test [ 13 , 21 ]. However, some children with KD can show bacterial pyuria and/or a positive nitrite test, indicating that there is a possibility of a coexisting UTI with KD in febrile children with pyuria and CRP elevation [ 17 , 22 ]. The clinical significance of pyuria observed in KD is controversial, but the presence of pyuria might be associated with the severity of systemic inflammation or coronary complications [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

Differentiating Kawasaki disease from urinary tract infection in febrile children with pyuria and C-reactive protein elevation

Han

Lee

2018

Ital J Pediatr

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BackgroundKawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present study investigated the clinical and laboratory findings that can differentiate KD from UTI in febrile children with pyuria and CRP elevation.MethodsMedical records were retrospectively reviewed for children with KD and those with UTI. The clinical and laboratory findings between the KD with pyuria group (n = 48) and the UTI group (n = 118) were compared.ResultsThe KD with pyuria group had older age (P < 0.001) and longer duration of fever (P < 0.001) than the UTI group. In blood tests, both groups showed increased CRP level, but the value of CRP was higher in the KD with pyuria group than in the UTI group (P < 0.001). The KD with pyuria group also showed higher values for liver enzymes than the UTI group (P < 0.001); > 70.0% of children in the KD with pyuria group, but < 20.0% of children in the UTI group possessed elevated liver enzymes (P < 0.001). On urinalysis, 40.7% of the UTI group had a positive nitrite test, but 0.0% of the KD with pyuria group had a positive nitrite test (P < 0.001).ConclusionsElevated liver enzymes are more specific to KD than to UTI, whereas a positive nitrite test is more specific to UTI than to KD. Our findings can be used as diagnostic clues to differentiate KD from UTI in febrile children with pyuria and CRP elevation.

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