Keywords Acute renal failure · Kawasaki disease · Yersinia pseudotuberculosis Sirs, I read with interest the article entitled “Acute renal fail- ure in typical Kawasaki disease” by Bonany et al. in this journal [1]. Since Kawasaki disease is systemic vasculi- tis, multiple organ involvement including the kidneys can develop; however, acute renal failure (ARF) has rarely been reported [1, 2]. As the authors pointed out, the patient’s age was higher than that of patients with Kawasaki disease. In addition, the patient’s ARF was caused by tubulointerstitial nephropathy [1]. From these findings, it is necessary to rule out Yersinia pseudotuber- culosis infection in this patient [3]. Y. pseudotuberculosis is a gram-negative coccobacillus, causing diarrhea, ab- dominal pain, fever, skin rash, conjunctivitis, erythema nodosa, and lymphadenopathy [3, 4]. A superantigen, Y. pseudotuberculosis-derived mitogen that is produced by Y. pseudotuberculosis, produces these clinical charac- teristics [4]. Typical Kawasaki disease-like findings de- veloped in 8.8% of patients with Y. pseudotuberculosis infection [5]. On the other hand, ARF occurred in 9.6%–13.6% of patients with Y. pseudotuberculosis in- fection [3, 6]. Therefore, ARF is more likely to develop in patients with Y. pseudotuberculosis infection, which mimics Kawasaki disease, than in patients with true Kawasaki disease. Moreover, renal histology of almost all patients with Y. pseudotuberculosis infection and ARF who underwent renal biopsy showed tubulointersti- tial nephritis [3, 6, 7, 8], as did the patient of Bonany et al. [1]. It is necessary to clarify whether patients with Kawasaki disease-like findings and ARF have Y. pseudo- tuberculosis infection, especially if tubulointerstitial nephritis causes their ARF. References 1. Bonany PJ, Bilkis MD, Gallo G, Lago N, Dennehy MV, Sosa del Valle JM, Vallejo G, Cánepa C (2002) Acute renal failure in typical Kawasaki disease. Pediatr Nephrol 17:329–331 2. Rhodes J, King ME, Aretz HT (1998) An 11-year-old girl with fe- ver, hypotension, and azotemia. N Engl J Med 339:1619–1626 3. Takeda N, Usami I, Fujita A, Baba K, Tanaka M (1991) Renal complications of Yersinia pseudotuberculosis infection in chil- dren. Contrib Microbiol Immunol 12:301–306 4. Abe J, Onimaru M, Matsumoto S, Noma S, Baba K, Ito Y, Kohsaka T, Takeda T (1997) Clinical role for a superantigen in Yersinia pseudotuberculosis infection. J Clin Invest 99: 1823–1830 5. Baba K, Takeda N, Tanaka M (1991) Cases of Yersinia pseudo- tuberculosis infection having diagnostic criteria of Kawasaki disease. Contrib Microbiol Immunol 12:292–296 6. Koo JW, Park SN, Choi SM, Chang CH, Cho CR, Paik IK, Chung CY (1996) Acute renal failure associated with Yersinia pseudotuberculosis infection in children. Pediatr Nephrol 10:582–586 7. Okada K, Yano I, Kagami S, Funai M, Kawahito S, Okamoto T, Imagawa A, Kuroda Y (1991) Acute tubulointerstitial nephritis associated with Yersinia pseudotuberculosis infection. Clin Nephrol 35:105–109 8.Fukumoto Y, Hiraoka M, Takano T, Hori C, Tsuchida S, Kikawa Y, Sudo M (1995) Acute tubulointerstitial nephritis in associa- tion with Yersinia pseudotuberculosis infection. Pediatr Nephrol 9:78–80 An author’s reply to this letter is available at http://dx.doi.org/10.1007/s00467-002-1028-6 T. Watanabe ( ✉ ) Department of Pediatrics, Niigata City General Hospital, 2–6-1 Shichikuyama, Niigata 950–8739 Japan e-mail: twata@hosp.niigata.niigata.jp Tel.: +81–25–2415151, Fax: +81–25-2483507 Pediatr Nephrol (2003) 18:200 DOI 10.1007/s00467-002-1027-7 LETTER TO THE EDITORS Toru Watanabe Acute renal failure in Kawasaki disease Published online: 21 December 2002 © IPNA 2002