Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Hyponatremia and Syndrome of Inappropriate Antidiuretic Hormone Secretion in Kawasaki Disease

  • Lim, Goh-Woon (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Lee, Mi-Na (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Kim, Hae-Soon (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Hong, Young-Mi (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Sohn, Se-Jung (Department of Pediatrics, Ewha Womans University School of Medicine)
  • Received : 2010.02.26
  • Accepted : 2010.04.21
  • Published : 2010.10.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: The pathogenesis of hyponatremia (serum sodium <135 mEq/L) in Kawasaki disease (KD) remains unclear. We investigated the clinical significance of hyponatremia, and the role of interleukin (IL)-6 and IL-1${\beta}$ in the development of hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (SIADH) in KD. Subjects and Methods: Fifty KD patients were prospectively enrolled and analyzed for clinical and laboratory variables according to the presence of hyponatremia or SIADH. Results: Thirteen KD patients (26%) had hyponatremia and 6 of these had SIADH. In patients with hyponatremia, the percentage of neutrophils (% neutrophils), C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were higher than in those without hyponatremia, while serum triiodothyronine (T3) and albumin were lower. Patients with hyponatremia had a higher incidence of intravenous immunoglobulin-resistance but this was not statistically significant. No differences existed between patients with and without SIADH with regard to clinical or laboratory variables and the incidence of IVIG-resistance. Serum sodium inversely correlated with % neutrophils, CRP, and NT-proBNP, and positively correlated with T3 and albumin. Serum IL-6 and IL-1${\beta}$ levels increased in KD patients and were higher in patients with hyponatremia. Plasma antidiuretic hormone increased in patients with SIADH, which tended to positively correlate with IL-6 and IL-1${\beta}$ levels. Conclusion: Hyponatremia occurs in KD patients with severe inflammation, while increased IL-6 and IL-1${\beta}$ may activate ADH secretion, leading to SIADH and hyponatremia in KD.

Keywords

References

  1. Laxer RM, Petty RE. Hyponatremia in Kawasaki disease. Pediatrics 1982;70:655.
  2. Lapointe N, Chad Z, Lacroix J, et al. Kawasaki disease: association with uveitis in seven patients. Pediatrics 1982;69:376-8.
  3. Mine K, Takaya J, Hasui M, Ikemoto Y, Teraguchi M, Kobayashi Y. A case of Kawasaki disease associated with syndrome of inappropriate secretion of antidiuretic hormone. Acta Paediatr 2004;93:1547-9. https://doi.org/10.1111/j.1651-2227.2004.tb02646.x
  4. Nakabayashi Y, Shimizu T. Hyponatremia in Kawasaki disease. Nippon Shoni Jinzobyo Gakkai Zasshi 2002;15:83-7. https://doi.org/10.3165/jjpn.15.83
  5. Gupta M, Noel GJ, Schaefer M, Friedman D, Bussel J, Johann-Liang R. Cytokine modulation with immune gamma-globulin in peripheral blood of normal children and its implications in Kawasaki disease treatment. J Clin Immunol 2001;21:193-9. https://doi.org/10.1023/A:1011039216251
  6. Kim DS. Serum interleukin-6 in Kawasaki disease. Yonsei Med J 1992;33:183-8. https://doi.org/10.3349/ymj.1992.33.2.183
  7. Maury CP, Salo E, Pelkonen P. Circulating interleukin-1beta in patients with Kawasaki disease. N Engl J Med 1988;319:1670-1. https://doi.org/10.1056/NEJM198812223192515
  8. Suzuki H, Uemura S, Tone S, et al. Effects of immunoglobulin and gamma-interferon on the production of tumour necrosis factor-alpha and interleukin-1beta by peripheral blood monocytes in the acute phase of Kawasaki disease. Eur J Pediatr 1996;155:291-6. https://doi.org/10.1007/BF02002715
  9. 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. https://doi.org/10.1210/jc.79.4.934
  10. Ohta M, Ito S. Hyponatremia and inflammation. Rinsho Byori 1999;47:408-16.
  11. Dajani AS, Taubert KA, Gerber MA, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-80. https://doi.org/10.1161/01.CIR.87.5.1776
  12. Berry PL, Belsha CW. Hyponatremia. Pediatr Clin North Am 1990;37:351-63. https://doi.org/10.1016/S0031-3955(16)36873-0
  13. 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
  14. Research committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Ministry of Health and Welfare: Tokyo;1984.
  15. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823-32.
  16. Cho HK, Sohn JA, Kim HS, Sohn S. Low T3 syndrome in Kawasaki disease: relation to serum levels of tumor necrosis factor-alpha, interleukin-6 and NT-proBNP. Korean J Pediatr 2009;52:234-41. https://doi.org/10.3345/kjp.2009.52.2.234
  17. Dahdah N, Siles A, Fournier A, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 2009;30:810-7. https://doi.org/10.1007/s00246-009-9441-2
  18. Lee H, Kim H, Kim HS, Sohn S. NT-proBNP: a new diagnostic screening tool for Kawasaki disease. Korean J Pediatr 2006;49:539-44. https://doi.org/10.3345/kjp.2006.49.5.539
  19. Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991;33:805-10. https://doi.org/10.1111/j.1442-200X.1991.tb02612.x
  20. Kobayashi T, Inoue Y, Takeuchi K, 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
  21. Eisenhut M. Changes in renal sodium transport during a systemic inflammatory response. Pediatr Nephrol 2006;21:1487-8. https://doi.org/10.1007/s00467-006-0199-y
  22. Smith PK, Goldwarer PN. Kawasaki disease in Adelaide: a review. J Paediatr Child Health 1993;29:126-31.
  23. Terai M, Honda T, Yasukawa K, Higashi K, Hamada H, Kohno Y. Prognostic impact of vascular leakage in acute Kawasaki disease. Circulation 2003;108:325-30. https://doi.org/10.1161/01.CIR.0000079166.93475.5F
  24. Koyanagi H, Nakamura Y, Yanagawa H. Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease. Acta Paediatr 1998;87:32-6. https://doi.org/10.1080/08035259850157831
  25. Boomsma F, van den Meiracker AH. Plasma A- and B-type natriuretic peptides: physiology, methodology and clinical use. Cardiovasc Res 2001;51:442-9. https://doi.org/10.1016/S0008-6363(01)00195-X
  26. Fujiwara T, Fujiwara H, Takemura G, et al. Expression and distribution of atrial natriuretic polypeptide in the ventricles of children with myocarditis and/or myocardial infarction secondary to Kawasaki disease: immunohistochemical study. Am Heart J 1990;120:612-8. https://doi.org/10.1016/0002-8703(90)90019-T
  27. Ohta K, Seno A, Shintani N, et al. Increased levels of urinary interleukin-6 in Kawasaki disease. Eur J Pediatr 1993;152:647-9. https://doi.org/10.1007/BF01955240
  28. Duke T, Molyneux EM. Intravenous fluids for seriously ill children: time to reconsider. Lancet 2003;362:1320-3. https://doi.org/10.1016/S0140-6736(03)14577-1

Cited by

  1. A case report of syndrome of inappropriate antidiuretic hormone secretion with Castleman’s disease and lymphoma vol.13, pp.1, 2010, https://doi.org/10.1186/1472-6823-13-19
  2. Natriuretic Peptides in Kawasaki Disease: the Myocardial Perspective vol.3, pp.1, 2010, https://doi.org/10.3390/diagnostics3010001
  3. Renal Manifestations and Imaging Studies of Kawasaki Disease vol.17, pp.2, 2010, https://doi.org/10.3339/jkspn.2013.17.2.86
  4. Comparative effectiveness of intravenous immunoglobulin from different manufacturing processes on Kawasaki disease vol.10, pp.2, 2010, https://doi.org/10.1007/s12519-014-0479-8
  5. Kawasaki Disease with Acute Respiratory Distress Syndrome after Intravenous Immunoglobulin Infusion vol.29, pp.4, 2010, https://doi.org/10.4266/kjccm.2014.29.4.336
  6. Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease vol.2015, pp.None, 2010, https://doi.org/10.1155/2015/689864
  7. Hyponatremia May Reflect Severe Inflammation in Children with Kawasaki Disease vol.19, pp.2, 2010, https://doi.org/10.3339/chikd.2015.19.2.159
  8. Hyponatraemia and neurological complications in children admitted with bronchiolitis vol.36, pp.3, 2010, https://doi.org/10.1080/20469047.2016.1162390
  9. SIADH in Systemic JIA Resolving After Treatment With an IL-6 Inhibitor vol.141, pp.1, 2010, https://doi.org/10.1542/peds.2016-4174
  10. A New Scoring System for Prediction of Intravenous Immunoglobulin Resistance of Kawasaki Disease in Infants Under 1-Year Old vol.7, pp.None, 2010, https://doi.org/10.3389/fped.2019.00514
  11. Predictive tool for intravenous immunoglobulin resistance of Kawasaki disease in Beijing vol.104, pp.3, 2010, https://doi.org/10.1136/archdischild-2017-314512
  12. Hyponatremia as an Inflammatory Marker of Lupus Activity Is a Fact or Fad: A Cross-Sectional Study vol.12, pp.None, 2010, https://doi.org/10.2147/oarrr.s237168
  13. A Case of Kawasaki Disease Complicated With Cerebral Salt-Wasting Syndrome vol.8, pp.None, 2010, https://doi.org/10.3389/fped.2020.00325
  14. Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease vol.62, pp.3, 2020, https://doi.org/10.1111/ped.14036
  15. Studying Clinical, Biologic and Echocardiography Criteria to Predict a Resistant Kawasaki Disease in Children vol.40, pp.8, 2010, https://doi.org/10.1097/inf.0000000000003144