Syndrome of inappropriate antidiuretic hormone secretion and Kawasaki disease

Sirs,

I read with interest the Letter to the Editor entitled “Kawasaki disease and hyponatremia” by Lee et al. [1]. The authors suggested that the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was one of the causes of hyponatremia in patients with Kawasaki disease (KD) and that serum cytokines such as interleukin (IL)-6 or IL-1 beta might contribute to the development of SIADH in such circumstances [1]. I agree with the comments of Dr. Lee et al. that SIADH has sometimes been reported in KD [2, 3] and cerebral vasculitis is thought to be a cause of SIADH in patients with KD [4]. On the other hand, Mine et al. recently suggested that inflammatory cytokines may be involved in the pathogenesis of SIADH in KD [5]. Many inflammatory cytokines, including IL-6 and IL-1 beta, are elevated during the acute phase of KD [4] and these cytokines may activate vasopressin secretion. As Dr. Lee et al. pointed out, further studies are necessary to confirm the possible relationship between serum cytokines and hyponatremia due to SIADH in KD [1], and there is a need to examine the various parameters, such as plasma vasopressin levels, concentrations of serum cytokines, serum osmolality, and urinary electrolytes and osmolality.