Paniz Pourpashang
1,2* 
1 Department of Pediatric Nephrology, Bahrami Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Pediatric Chronic Kidney Disease Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Kawa-COVID-19 represents a new pediatric inflammatory syndrome associated with SARS-CoV-2 infection that mimics but is distinct from classic Kawasaki disease. Kawasaki-like disease associated with COVID-19 is a serious inflammatory condition that emerged during the COVID-19 pandemic. In Kawa-COVID-19, autoantibodies specifically target endothelial cells by recognizing both constitutive and induced endothelial antigens, often due to molecular mimicry, leading to complement activation, immune-mediated cytotoxicity, and endothelial dysfunction. These processes collectively contribute to vascular inflammation, coagulopathy, and the multisystem manifestations of the disease. This description incorporates the current evidence on how autoantibodies target endothelial cells in Kawa-COVID-19, highlighting key immunopathological mechanisms underlying vascular injury. Additionally, acute kidney injury, in this disease can be prerenal due to hypoperfusion or heart failure or intrinsic renal AKI from tubulointerstitial nephritis, hemolytic uremic syndrome, immune-complex nephropathy, or causes related to Kawasaki disease shock syndrome.