Kawasaki disease (KD), also called cutaneous mucosal lymph node syndrome, is the most common vasculitic disease of childhood. It was first reported by Dr. Tomisaku Kawasaki in Japan in 1967 and the disease was named after him. Its incidence is on the rise in many countries. Kawasaki disease is rare in adults and mainly affects children younger than 5 years of age. It is typically a self-limiting disease, and if left untreated its clinical course is characterized by a fever and acute inflammatory response lasting about 11 days. Kawasaki disease can lead to a number of complications, of which dilatation and aneurysm formation due to inflammatory injury of the coronary arteries (coronary arteries) is a hot topic of clinical treatment today, but non-coronary complications of Kawasaki disease can also be life-threatening in children. This article reviews the current research progress of non-coronary complications caused by Kawasaki disease, hoping to improve its clinical understanding. Shock is a clinical syndrome characterized by neurohumoral factor dysregulation and acute circulatory disturbances due to acute circulatory insufficiency caused by various serious pathogenic factors. The causative factors include hemorrhage, trauma, poisoning, burns, asphyxia, infection, allergy, and cardiac pump failure, etc. Among them, shock caused by extreme cardiac decompensation is called cardiogenic shock. Although cardiogenic shock due to acute Kawasaki disease is uncommon, it has been reported more and more recently. Some authors call it Kawasaki disease shock syndrome (KDSS), and its mechanism may be due to arrhythmia, ischemic cardiomyopathy, abnormal valve function, endocarditis and myocarditis caused by acute Kawasaki disease. The diagnostic criteria are Kawasaki disease complicated by shock and hypotension, with clinical manifestations of persistent systolic low pressure (at least 20% lower than baseline blood pressure values) or hypoperfusion, a potentially life-threatening complication. Although the coronary complications of Kawasaki disease are widely appreciated, KDSS is a condition that is easily overlooked by pediatricians. Clinicians should be alert to the development of Kawasaki disease shock syndrome (KDSS). Once KDSS occurs the currently accepted treatment is mainly high-dose intravenous gammaglobulin (IVIG) therapy, volume expansion, treatment with vasoactive drugs (dobutamine, dopamine, epinephrine, etc.) and anti-inflammatory symptomatic therapy when necessary. After proper and timely treatment, children with Kawasaki disease complicated by shock generally have a better prognosis. Macrophage activation syndrome (MAS), also known as secondary or reactive phagocytic lymphohistiocytosis (HLH), is an excessive activation and proliferation of T lymphocytes and macrophages, mainly secondary to infections, tumors, rheumatic diseases and other inflammatory processes, and can be caused by Kawasaki disease. The main clinical features are persistent hyperthermia, hepatosplenomegaly, hepatocytopenia, severe hepatic impairment, elevated serum ferritin, elevated LDH, hypofibrinogenemia, and hypertriglyceridemia. It has been reported that MAS can also occur in children with acute Kawasaki disease, but the relationship between the two and the mechanism of occurrence are not fully understood, and it is speculated that it may be due to abnormal lymphocytes and macrophages and cause a cytokine storm, resulting in an abnormal immune state of the body. After IVIG and aspirin treatment, 10-15% of children still have persistent fever. Al-Eid et al. concluded that we should be alert for the development of macrophage activation syndrome in children with enlarged lymph nodes, erythrocyte, leukocyte or thrombocytopenia and coagulation abnormalities in these children who are usually considered to have a recurrence of Kawasaki disease. Hypocardial contraction can be caused by myocarditis, cardiomyopathy, or reduced left ventricular contractility. Yutani et al. reported 201 children with Kawasaki disease who were followed up for 11 years from the onset of Kawasaki disease and had regular right ventricular myocardial biopsies to assess myocardial changes, showing that myocardial abnormalities, including myocardial fibrosis, myocardial disorganization, abnormal collateral formation, and cardiomyocyte hypertrophy, could be seen from all phases of the disease. seen in all phases after the onset of disease. In heart failure, a third heart sound, gallop rhythm, can be heard and the murmur is enhanced during fluid replacement. Normal myocardial contractility usually returns gradually after IVIG, implying that cytokines play a role in myocardial dysfunction. Nevertheless, cellular components also play a role in this process, and lymphocytic infiltration and proliferation of fibrous tissue can still be seen in myocardial biopsies years after the acute phase of Kawasaki disease has passed, especially in children not treated with IVIG. The most common complication of Kawasaki disease is coronary artery aneurysm. Since it is a disease with systemic vasculitis as the main pathological change, it can involve arteries, veins and capillaries, and the possibility of aneurysm and stenosis of the arteries of the body circulation also occurs, but it is very rare and rarely reported. Some Japanese scholars believe that arterial lesions in the body circulation mainly occur in cases of combined coronary artery aneurysms. However, a recent study by Fatima et al. showed that endothelial dysfunction-induced arteriopathy can also occur in children without combined coronary artery aneurysms. Of course, this result needs to be further confirmed in a larger clinical study. In China, there are few reports on Kawasaki disease combined with coronary artery aneurysm. All of them were given IVIG at a dose of 2g/kg.d and aspirin 30-50mg/kg.d orally after admission, and 17 of them had coronary artery complications and were given dipyridamole 1mg/kg.d orally. After regular treatment with aspirin and dipyridamole, the child was reexamined 16 months after discharge and showed that the bilateral axillary aneurysms disappeared. Body circulation aneurysms that are not combined with thrombosis do not require special treatment and can be treated with IVIG and long-term oral anti-inflammatory treatment with aspirin and antiplatelet therapy with dipyridamole. Most of the body circulation aneurysms can be retracted within 2-3 years, and the prognosis is good. 5. Urologic and renal diseases Urologic and renal diseases are rare among the complications of Kawasaki disease. In reported cases, these complications mainly include acute interstitial nephritis, moderate proteinuria, and acute renal failure (ARF). The common causes of acute interstitial nephritis are mainly drugs, infections, metabolic diseases, malignancies, and autoimmune diseases such as systemic lupus erythematosus and ANCA-associated vasculitis. IVIG can be used successfully in different types of glomerulonephritis, but in recent years, more attention has been paid to the complications of renal system damage caused by IVIG, with high-risk factors such as previous renal system disease, hypernatremia, multiple organ dysfunction, and people over 65 years of age.