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: 2.72). 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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    • "Ce qui nous incite a ` utiliser la PCT dans l'indication de l'UCR vue les risques non né gligeables de cet examen ; infectieux, traumatique et irradiant. Plusieurs e ´ tudes ont montré qu'il y a une corré lation positive entre le taux e ´ levé de la PCT a ` l'admission et la formation de cicatrices ré nales confirmé es par la scintigraphie au DMSA pratiqué e cinq a ` six mois aprè s l'e ´ pisode aiguë [1] [3] [8] [24]. Dans l'e ´ tude de Pecile et al. [3], le taux moyen de la PCT dans le groupe d'enfants ayant des lé sions ré nales totalement ré versibles e ´ tait de 3,25 AE 3,5 ng/mL versus 7,48 AE 8,4 ng/mL dans le groupe d'enfants ayant des lé sions partiellement ré versibles ou dont l'e ´ volution e ´ tait compliqué e par la constitution de cicatrices ré nales. "
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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.
    Full-text · Article · Jun 2013 · Pathologie Biologie
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    • "Ce qui nous incite a ` utiliser la PCT dans l'indication de l'UCR vue les risques non né gligeables de cet examen ; infectieux, traumatique et irradiant. Plusieurs e ´ tudes ont montré qu'il y a une corré lation positive entre le taux e ´ levé de la PCT a ` l'admission et la formation de cicatrices ré nales confirmé es par la scintigraphie au DMSA pratiqué e cinq a ` six mois aprè s l'e ´ pisode aiguë [1] [3] [8] [24]. Dans l'e ´ tude de Pecile et al. [3], le taux moyen de la PCT dans le groupe d'enfants ayant des lé sions ré nales totalement ré versibles e ´ tait de 3,25 AE 3,5 ng/mL versus 7,48 AE 8,4 ng/mL dans le groupe d'enfants ayant des lé sions partiellement ré versibles ou dont l'e ´ volution e ´ tait compliqué e par la constitution de cicatrices ré nales. "
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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.
    Full-text · Article · Mar 2013 · Pathologie Biologie
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    • "None of the items investigated in the regression analysis showed a significant association with the DOR. Thirteen studies investigated clinical or laboratory-based tests[22,25,40-50]. The tests investigated varied greatly, and in general, showed poor performance. "
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    ABSTRACT: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required.
    Full-text · Article · Feb 2005 · BMC Pediatrics
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