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

Leroy, Sandrine; Fernández-López, Anna; Nikfar, Roya; Romanello, Carla; Bouissou, F; Gervaix, Alain; Gürgöze, Metin Kaya; Bressan, Silvia; Smolkin, Vladislav; Tuerlinckx, David; Stefanidis, Constantinos J.; Vaos, Georgos; Leblond, Pierre; Güngör, Fırat; Gendrel, D.; Chalumeau, Martin

doi:10.1542/peds.2012-2408

Cited by 95 publications

(54 citation statements)

References 40 publications

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“…The literature demonstrates that different diagnostic and treatment pathways are followed for adults compared with children even though Talner and et al underlined the importance of standardizing the definition of APN about 20 y ago (22,23). The quest to improve accurate rapid diagnosis of APN is an area of intense research (24). In the present study, plasma NGAL levels were significantly higher in children with APN than in those with lower UTIs and the levels in the APN and lower UTI groups decreased after antibiotic treatment compared to levels before treatment.…”

Section: Discussionmentioning

confidence: 99%

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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Background:The identification of acute pyelonephritis (APN) is still a challenge. Methods: Patients admitted for their first urinary tract infection (UTI) were enrolled. Plasma neutrophil gelatinaseassociated lipocalin (NGAL) levels were measured at admittance and after treatment. Laboratory, clinical, and imaging results were compared between children with and without APN. results: A total of 123 patients were enrolled (53 APN and 70 lower UTI). After adjusting for age and gender, plasma NGAL levels were higher in the APN group than in the lower UTI group (233 (129-496) ng/ml vs. 71 (50.8-110) ng/ml, P < 0.001). NGAL levels were correlated with the serum levels of leukocytes, C-reactive protein, and creatinine, as well as fever duration (P < 0.05). Multivariable analysis revealed that logtransformed plasma NGAL was an independent predictor of APN (P < 0.05). Receiver operating curve analysis showed a good diagnostic profile of NGAL for identifying APN (area under the curve 0.864) with a best cut-off value of 102.5 ng/ml. The NGAL levels in both two groups decreased after treatment compared to levels before treatment (P < 0.001). conclusion: Plasma NGAL can be a sensitive predictor for identifying APN and monitoring the treatment response of pediatric UTI. u rinary tract infections (UTIs) are among the most common bacterial infections in children (1). Early detection and proper management of UTIs is important since UTIs involving the kidney may cause permanent renal scarring and be a risk factor for future development of renal insufficiency (2). Establishing the diagnosis of acute pyelonephritis (APN) requires imaging with 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy to view renal parenchymal involvement (3). Although a DMSA scan is considered to be very sensitive in the assessment of renal damage, it is expensive, not readily available in all centers, and exposes the patients to radiation (4). Therefore, a more practical and accessible tool to determine the presence of renal parenchymal involvement could be helpful for the timely management of UTIs.Neutrophil gelatinase-associated lipocalin (NGAL), as a member of the lipocalin superfamily, is produced from the nephron in response to tubular epithelial damage (5). It has been identified as one of the earliest and potentially one of the most indicative biomarkers of acute kidney injury (AKI) from a diverse array of conditions and can differentiate between prerenal and intrinsic causes (6,7). Urinary NGAL (uNGAL) levels increase in patients with different causes of nephropathies (8,9) and might be a valuable tool in monitoring the treatment response of various renal diseases (10,11).As an iron-carrier protein derived from human neutrophils, NGAL also plays an important role in the innate immune response to bacterial infection (12). Experimentally, NGAL was capable of blocking Escherichia coli growth under ironpoor conditions, but NGAL with siderophore iron was not (13). NGAL-knockout mice demonstrated substantially increased mortality after intraperitoneal i...

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Section: Discussionmentioning

confidence: 99%

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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“…Procalcitonin as an acute phase reactant was more superior compared to CRP or white blood cell count for identifying APN during early stages of UTI [15]. Further from the Study of the Working Group of the Clinical Practice Guidelines for UTI in children, we can identify the recommendations of the possibility of acute pyelonephritis from various clinicobiological features like >38°C fever, systemic involvement, serum procalcitonin and C-reactive protein as well as interleukin-6 in urine.…”

Section: Discussionmentioning

confidence: 97%

First Febrile Urinary Tract Infection – Clinico-Biological Correlation with Imaging Studies - A Prospective Study

Vijayakumar¹,

Geminiganesan²,

Priyadarshini³

et al. 2014

J Nephrol Ther

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Febrile urinary tract infection is one of the commonest infections in the childhood. Unrecognized and untreated childhood UTI can lead to scarring of the growing kidneys with subsequent hypertension and renal failure. This study has been done at a tertiary care medical centre to study the clinico -biological and imaging correlation in children with first episode of febrile UTI. Renal function tests, ultrasonogram, DMSA and MCU were done according to ISPN and institutional protocol. Imaging was done on follow up as per need. Majority of the children were found to be in 1 to 5 years age (68%) group and overall there was female preponderance (n=80; 53%). Dysuria was the commonest presentation in febrile UTI and E. coli, the commonest organism isolated. USG was found abnormal in 57.6% of children and DMSA done in acute phase picked up pyelonephritis in 81.5%. MCU revealed VUR in 39% of the study population. The study underlines the importance and efficacy of various investigations apart from the clinical presentation in diagnosing UTI and defining the associated risk factors.

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“…22 Several novel biomarkers have recently been documented as diagnostic and prognostic tools in diseases such as pediatric acute kidney injury, [23][24][25][26][27][28][29][30][31][32][33][34][35][36] and urinary tract infection. [37][38][39][40][41][42][43] Similarly, the utility of biomarkers in childhood idiopathic nephrotic syndrome has been reported; [12][13][14][15][16][17][18][19][20] their application constitutes a noninvasive approach in diagnostic nephrology, as they can be used as diagnostic and prognostic tools in idiopathic nephrotic syndrome, as well as discriminatory tools in distinguishing SRNS from SSNS (Table 1).…”

Section: The Diagnostic Prognostic and Discriminatory Roles Of Biommentioning

confidence: 99%

The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence

Uwaezuoke

2017

IJNRD

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Two histological subtypes of idiopathic nephrotic syndrome are commonly recognized in children, namely minimal change nephropathy and focal segmental glomerulosclerosis. Children with minimal change nephropathy (the majority of whom are steroid-sensitive) and focal segmental glomerulosclerosis (the majority of whom are steroid-resistant) require early identification in order to ensure appropriate therapeutic intervention and better outcome. Although renal biopsy and histology remain the ideal diagnostic steps to identify these histological subtypes, reports indicate that serum and urinary biomarkers are now being utilized in the investigation of childhood idiopathic nephrotic syndrome. This paper aims to review the diagnostic and prognostic utility of novel biomarkers in childhood idiopathic nephrotic syndrome and to highlight their role in differentiating steroid-sensitive nephrotic syndrome (SRNS) from steroid-resistant nephrotic syndrome (SSNS). Using the terms "idiopathic nephrotic syndrome," "children," and "biomarkers" the PubMed database was searched for relevant studies related to the topic. Biomarkers such as adiponectin, neopterin, β2-microglobulin, and N-acetyl-β-D glucosaminidase were reported as diagnostic markers. In addition to neopterin and N-acetyl-β-D glucosaminidase, urine vitamin D-binding protein and α1β-glycoprotein were shown to differentiate SRNS from SSNS while N-acetyl-β-D glucosaminidase and β2-microglobulin could predict steroid responsiveness and renal outcome in SRNS. Although progress has been made in demonstrating the diagnostic and prognostic utility of these biomarkers, their limited availability in most laboratories has precluded a complete paradigm shift from the conventional renal biopsy. Nevertheless, further longitudinal studies are required to establish their usefulness as noninvasive predictors of disease response to immunosuppressive therapy.

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

Abstract: Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring.

Cited by 95 publications

References 40 publications

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

First Febrile Urinary Tract Infection – Clinico-Biological Correlation with Imaging Studies - A Prospective Study

The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence

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