Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results

Abstract

In order to establish the most reliable marker for distinguishing urinary tract infections (UTI) with and without renal parenchymal involvement (RPI), we recorded the clinical features and admission leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum procalcitonin (PCT) in 57 children (including 43 girls) aged 2-108 months admitted with a first episode of UTI. RPI was evaluated by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. To establish cut-off points for ESR, CRP, and PCT, we used receiver operating characteristics curves and compared the area under the curve for ESR, CRP, and PCT. Twenty-seven children were diagnosed as having RPI based on positive renal scintigraphy. A body temperature of >38 degrees C, a history of diarrhea, and poor oral intake were more common in patients with RPI. ESR, CRP, and PCT, but not leukocyte count, were significantly higher in patients with RPI (P < 0.001). PCT was more sensitive and specific for the diagnosis of upper versus lower UTI than ESR and CRP. Using a cut-off value of 0.85 ng/ml, PCT had the best performance, with sensitivity, specificity, and positive and negative predictive values of 89%, 97%, 96%, and 91% respectively. Serum PCT is a better marker than ESR, CRP, and leukocyte count for the early prediction of RPI in children with a first episode of UTI.

Predictors of abnormal renal cortical scintigraphy in children with first urinary tract infection: the importance of time factor

“…Conversely, Krzemien et al [17] and Biggi et al [18] found no such correlation between fever and DMSA scan abnormalities. Also, Kotoula et al [19] reported that body temperature of 38°C, as well as a history of diarrhea and poor oral intake, is more common in patients with abnormal DMSA scan findings. They also reported the value of procalcitonin (PCT) for the diagnosis of upper versus lower UTI with reasonably high sensitivity, specificity, and positive and negative predictive values (89, 97, 96, and 91%, respectively), which were more than those of the conventionally used lab tests such as ESR and CRP.…”

Association of Procalcitonin With Acute Pyelonephritis and Renal Scars in Pediatric UTI

“…One article was not included because of absence of DMSA scan data. Finally, 18 articles were included, representing 13 centers as follows: Afula (Israel), 28 Ahvaz (Iran), 33 Antalya (Turkey), 22 Athens (Greece), 27 Barcelona (Spain), 19,20 Elazig (Turkey), 26 Geneva (Switzerland), 17,21,31 Lille (France), 25 Padova (Italy), 32 Thrace (Greece), 29,30 Toulouse (France), 16 Udine (Italy), 23 and Yvoir (Belgium). 24 3 months later if available) renal DMSA scintigraphy were included.…”

Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy

“…CRP and PCT were commonly used in this area particularly at the time of acute infection. [37][38][39][40][41] Unlike the reports above, we studied inflammatory markers at UTI free period to evaluate whether the inflammatory process continued independent from infection. However, we found these markers were in normal ranges and not associated either with RS or VUR grade.…”