Diagnostic significance of clinical and laboratory findings to localize site of urinary infection

Abstract

The aim of this study was to define in children younger than 2 years of age the diagnostic significance of clinical and laboratory findings to localize site of febrile urinary tract infection. We reviewed the records of 185 children younger than 2 years of age admitted to hospital with febrile urinary tract infection. Patients were divided into having either acute pyelonephritis or acute cystitis according to the presence or absence of acute lesions on dimercaptosuccinic acid (DMSA) renal scintigraphy. Clinical and laboratory [white blood cell count (WBC), urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] findings were compared between the two groups using Student's t test, chi-square test, and multivariate analysis. Patients with pyelonephritis had statistically significant higher age, WBC, ESR, and CRP than those with cystitis. Although the sensitivity of the tests was 80-100%, their specificity was <28%. On multivariate analysis, 33% of patients with cystitis were diagnosed as having pyelonephritis, whereas 22% of those with pyelonephritis were considered to have cystitis. Given the low specificity of clinical findings and available laboratory tests to define the site of urine infection in this age group, we recommend DMSA renal scintigram as the test of choice to make the diagnosis of acute pyelonephritis in these patients.

Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis

“…The frequency of acute renal changes was higher in the upper poles of the kidneys. These findings were in agreement with the results as reported in the literature [22][23][24]. Peripheral cortical defects were not associated with any loss of volume, in comparison to some authors' results that showed lesions with scintigraphic presentation suggesting scars [19].…”

“…Abnormal initial DMSA scan in our study could help to detect infected kidneys at risk of subsequent scarring and those children who are at risk of future complications [20,24]. The early definition of such a high-risk group may be of interest, particularly in distant geographical areas in our country, where compliance with treatment and follow-up may be low.…”

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

“…Según los estudios, el valor de PCR es significativamente más alto al momento del ingreso cuando se detecta daño renal por gammagrafía con DMSA tras una pielonefritis. [21][22][23][24] Del mismo modo, en este estudio, se detectó mayor nefroesclerosis en los pacientes con valores positivos de PCR, y se halló una diferencia estadísticamente significativa entre estos pacientes y aquellos con valores negativos de PCR (p < 0,0001).…”

Çocuklarda 99mTc-Dimerkaptosüksinik Asid ile Sintigrafik Görüntü Yapılmaksızın Piyelonefrit ve Sistit Tanısı Ayırt Edilebilir mi?

“…However, some studies have shown that fever is not enough for the diagnosis of pyelonephritis, as a sole indicator 9,11 .…”