Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #136

UTILITY OF URINALYSIS IN KAWASAKI DISEASE

P. Rosen, T. B. Graham

Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; ²Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Background: Current diagnostic criteria for Kawasaki disease (KD) are imperfect. The formation of coronary aneurysms in KD patients is unpredictable. Sterile pyuria has been reported in patients with KD.
Purpose: To determine the prevalence of white blood cells (WBCs) in urine in patients with KD. To determine if sterile pyuria is associated with the formation of coronary aneurysms in KD.
Methods: Pediatric patients with a discharge diagnosis of KD from a tertiary care children's hospital between January 1991 and December 2001 were identified. Patients were included if 5 of 6 diagnostic criteria, or 4 criteria plus the presence of coronary artery aneurysms were documented. Patients were excluded if information from their Kawasaki hospitalization was unobtainable or if they did not meet diagnostic criteria for KD. Extracted from the charts was information regarding demographics, KD diagnostic criteria, time to treatment with IVIG, urine WBC count, urine culture, echocardiography, ESR, and platelet count.
Results: 123 patients were identified who met diagnostic criteria for KD. Of these, 96.7% had fever 5 days, 96.7% had conjunctivitis, 87.7% had cervical lymphadenopathy, 98.3% had rash, 94.3% had lip or oral mucosa changes, and 89.3% had extremity changes. Initial or follow-up echocardiogram showed coronary aneurysm in 26.8% of patients. ESR was elevated (20 mm/hr) in 93.5% of patients. Platelet count was low ([lt>150) in 1.6% of patients, normal in 34.1%, and elevated (350) in 64.3%. UA results were obtained from 101 of 123 patients (82.1%). Of the 101 UAs, 56% were positive for pyuria (5 WBC/HPF). 19 of the 57 (33%) patients with pyuria developed coronary aneurysms compared with 8 of 44 (18%) patients without pyuria (OR=2.3; 95% CI 0.8-6.5)
Conclusions: The incidence of pyuria in patients who met KD criteria was 56% in our cohort. There was no statistically significant association of pyuria with the development of coronary aneurysms in patients with Kawasaki disease.