Article

Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection.

Serveis de Microbiologia, Hospital Universitari Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Spain.
The Pediatric Infectious Disease Journal (Impact Factor: 3.14). 06/2003; 22(5):438-42. DOI: 10.1097/01.inf.0000066161.48499.0e
Source: PubMed

ABSTRACT Urinary tract infection (UTI) in young children carries the risk of parenchymal damage and sequelae. The location of the infection within the urinary tract influences decisions regarding both therapeutics and follow-up. Because clinical features and laboratory markers of infection at an early age are not specific, it is difficult to make a distinction between lower UTI and acute pyelonephritis. Procalcitonin (PCT) has been studied as a marker of severe bacterial infection. The aim of this study was to test the usefulness of PCT concentration in serum to distinguish between uncomplicated UTI and severe acute pyelonephritis with renal scars.
PCT was measured by immunoluminometric assay in serum samples from children with microbiologically documented infection. Severe renal involvement was assessed by 99mTc-dimercaptosuccinic acid gammagraphy done 5 to 6 months after the episode to check for the presence of parenchymal scars. C-reactive protein (CRP) and leukocyte count were also measured.
PCT at presentation showed a significant correlation (P < 0.001) with the presence of renal scars in children with UTI. Using a cutoff of 1 ng/ml for PCT and 20 mg/l for CRP, sensitivity and specificity in distinguishing between urinary tract infection with and without renal damage were 92.3 and 61.9%, respectively, for PCT and 92.3 and 34.4% for CRP. Positive and negative predictive values were 32 and 97.5%, respectively, for PCT and 23 and 95%, respectively, for CRP.
A low PCT value at admission indicates a low risk of long term renal scarring. Increased PCT values at admission correlate with the presence of scars. PCT values have proved to be more specific than CRP and leukocyte count for identifying patients who might develop renal damage.

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    ABSTRACT: Objective The aim of this study is to compare two biologic parameters; C-reactive protein (CRP) and procalcitonin (PCT) in the detection of acute renal lesions assessed by DMSA scintigraphy in the urinary tract infection in child.DesignIn a prospective study, serum PCT, CRP and leukocyte counts were measured for children admitted, between January and December 2010, with a first episode of febrile urinary tract infection.ResultsSeventy-five children were enrolled in the study. Thirty-three patients had renal lesions (group A) and 42 had a normal DMSA scintigraphy (group B). The mean PCT level was significantly higher in group A than in group B (8.81 ng/mL versus 1.7 ng/mL, P = 0.01). In this study, using receiver operating characteristic (ROC) curve, we identified that the optimal cut-off value with ideal sensitivity and specificity for PCT in detection of renal lesions was 0.76 ng/mL and for CRP, it was 70 mg/L. The sensitivity, the negative predictive value and the indice of Youden of the cut-off value of PCT were significantly higher than CRP (82% versus 70%; 84% versus 70% and 0.58 versus 0.25).Conclusions This study confirmed that the serum PCT level was more sensitive and specific than the CRP in the detection of renal lesions in the first urinary tract infection in child.
    Pathologie Biologie 06/2013; 61(3):93–98. DOI:10.1016/j.patbio.2013.01.010 · 1.07 Impact Factor
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    ABSTRACT: OBJECTIVE: The aim of this study is to compare two biologic parameters; C-reactive protein (CRP) and procalcitonin (PCT) in the detection of acute renal lesions assessed by DMSA scintigraphy in the urinary tract infection in child. DESIGN: In a prospective study, serum PCT, CRP and leukocyte counts were measured for children admitted, between January and December 2010, with a first episode of febrile urinary tract infection. RESULTS: Seventy-five children were enrolled in the study. Thirty-three patients had renal lesions (group A) and 42 had a normal DMSA scintigraphy (group B). The mean PCT level was significantly higher in group A than in group B (8.81ng/mL versus 1.7ng/mL, P=0.01). In this study, using receiver operating characteristic (ROC) curve, we identified that the optimal cut-off value with ideal sensitivity and specificity for PCT in detection of renal lesions was 0.76ng/mL and for CRP, it was 70mg/L. The sensitivity, the negative predictive value and the indice of Youden of the cut-off value of PCT were significantly higher than CRP (82% versus 70%; 84% versus 70% and 0.58 versus 0.25). CONCLUSIONS: This study confirmed that the serum PCT level was more sensitive and specific than the CRP in the detection of renal lesions in the first urinary tract infection in child.
    Pathologie Biologie 03/2013; · 1.07 Impact Factor
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    ABSTRACT: Objective: Urinary tract infection (UTI) is a common disease in children. The distinction between upper and lower UTI in children is associated with some ambiguities. The objective of this study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of procalcitonin (PCT) compared to C-reactive protein (CRP) in predicting renal involvement. Methods: Serum concentrations of PCT and CRP in blood samples of 111 children with UTI were measured. Renal parenchymal involvement was evaluated with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. Sensitivity, specificity, PPV and NPV were determined. Findings: Out of 111 children, 52 (46.8%) were shown to have acute renal involvement, 23 (20.7%) lower UTI, and 36 (32.5%) refused to be examined by DMSA renal scan. PCT was positive in 36 (69.2%) patients with upper UTI and 12 (52.2%) with lower UTI. The sensitivity, specificity, PPV and NPV obtained for PCT and CRP were 70.6, 45.5, 75, 40% and 96.2, 4.3, 69.4, and 33.3%, respectively. Conclusion: No significant correlation was found between renal parenchymal involvement and serum levels of PCT and CRP. However, the results demonstrated that the PCT was a better diagnostic test compared to CRP.