Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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An 8-month-old Male Infant with High Grade Vesicoureteral Reflux who Developed Incomplete Kawasaki disease after Recurrent Pyelonephritis

급성 신우신염이 재발한 후 불완전 가와사끼병이 발생한 고도의 방광요관역류가 있는 8개월 남아

  • Jung, Su Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Park, Sung Eun (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Jun Ho (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 정수진 (CHA의과대학교 분당차병원 소아청소년과) ;
  • 박성은 (CHA의과대학교 분당차병원 소아청소년과) ;
  • 이준호 (CHA의과대학교 분당차병원 소아청소년과)
  • Received : 2014.01.28
  • Accepted : 2014.02.20
  • Published : 2014.04.30
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Abstract

Kawasaki disease (KD) is a systemic vasculitis that can affect many organ systems. Renal manifestations include pyuria, hematuria, proteinuria, tubulointerstitial nephritis, acute renal failure, hemolytic uremic syndrome, or renal scarring. Although its precise pathogenesis remains unknown, it is considered an autoimmune disease. In the literature, it has been reported that KD may develop in conjunction with urinary tract infections. However, many of these previous studies did not use imaging methods such as renal sonograms, dimercaptosuccinic acid renal scans, and voiding urethrocystograms. We report a case of an 8-month old male infant with high grade vesicoureteral reflux, who developed incomplete KD after recurrent pyelonephritis. Acute pyelonephritis can be an early manifestation of KD. Such cases require the evaluation of urinary tract anomalies according to the guidelines for the management of urinary tract infections.

가와사끼병은 전신성 혈관염을 일으키는 질환중의 하나로 여러 장기들을 침범할 수 있다. 신장증세로는 농뇨, 혈뇨, 단백뇨, 간질성 신염, 급성 신부전증, 용혈성 요독 증후군, 신반흔 등이 있다. 가와사끼병의 신장침범에 대한 병리기전은 아직 알려져 있지 않지만, 자가면역질환으로 인한 것으로 사려된다. 가와사끼병이 요로감염 이 후에 발병한다는 몇몇 보고들이 있었다. 하지만, 이미 보고된 논문들에 포함된 많은 요로감염 환자들은 신장방광 초음파, DMSA 스캔이나 배뇨중 요도방광조영술 등을 모두 받은 경우는 없었다. 이에 저자들은 급성 신우신염이 재발한 후 불완전 가와사끼병이 발생한 고도의 방광요관역류가 있는 8개월 남아를 보고하는 바이다. 급성 신우신염은 가와사끼병의 초기 증세일 수 있다. 그런 경우, 환아가 가와사끼병으로 확진되더라도 요로감염 진료지침에 따라 요로기형에 대한 이미지 검사를 시행할 필요가 있다고 생각한다.

Keywords

References

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