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

Gilani, Kambiz; Esfeh, Jamak Modaresi; Gholamrezanezhad, Ali; Gholami, Abdollah; Mamishi, Setareh; Eftekhari, Mohammad; Beiki, Davood; Fard-Esfahani, Armaghan; Fallahi, Babak; Anvari, Arash

doi:10.1007/s11255-009-9650-x

Cited by 22 publications

(12 citation statements)

References 23 publications

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“…Because of high inflammatory markers and renal parenchymal involvement in the DMSA scan we assigned these infants to the APN group. Some authors demonstrated that renal parenchymal involvement in UTI is related to delayed treatment and longer duration of fever before antibiotic treatment [8, 13, 30, 43]. In our study fever ≥ 38°C was present significantly more often and duration of fever before antibiotic treatment was significantly longer in the group with APN compared to the lower UTI group.…”

Section: Discussionsupporting

confidence: 55%

Serum neutrophil gelatinase-associated lipocalin for predicting acute pyelonephritis in infants with urinary tract infection

Krzemień

Pańczyk-Tomaszewska

Kotuła

et al. 2019

cejoi

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Introduction Fever and elevated inflammatory markers have been used for diagnosis of acute pyelonephritis (APN) in infants with urinary tract infection (UTI). The aim of the study was to compare the usefulness of serum neutrophil gelatinase-associated lipocalin (sNGAL) with inflammatory markers for predicting APN in infants with UTI. Material and methods The prospective study included 46 infants with a first episode of UTI, divided into two groups (APN 23, lower UTI 23), according to the DMSA scan results. The following laboratory tests were performed: sNGAL, PCT, CRP, WBC, and ESR. Results Significantly elevated levels of sNGAL, PCT, CRP, and ESR were observed in infants with APN compared to those with lower UTI. Higher sNGAL, CRP, and ESR values, presence of fever, and longer duration of fever before antibiotic treatment were associated with APN [odds ratio (OR) 1.02, 1.27, 1.03, 13.46, 2.12, respectively]. Receiver operating characteristic (ROC) analysis showed better diagnostic profiles for sNGAL, PCT, and CRP than for ESR for predicting APN [area under the curve (AUC) 0.808, 0.819, 0.841, and 0.750, respectively]. The appropriate cut-off values of sNGAL, PCT and CRP were 100.8 ng/ml, 0.15 ng/ml, 5.3 mg/dl (all sensitivity and specificity 82.6%), and that of ESR was 40 mm/h (sensitivity 78.3%, specificity 60.9%). Conclusions sNGAL shows similar usefulness as PCT and CRP for predicting APN in infants with UTI, the diagnostic value of ESR is smaller, and WBC is not useful at all. The presence of fever and longer duration of fever are important predictors of APN in infants with UTI.

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Section: Discussionsupporting

confidence: 55%

Serum neutrophil gelatinase-associated lipocalin for predicting acute pyelonephritis in infants with urinary tract infection

Krzemień

Pańczyk-Tomaszewska

Kotuła

et al. 2019

cejoi

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“…However, some reports have indicated that CRP levels have low Sp for detecting true APN. 9 10 Ansari Gilani, et al 11 reported in their study that CRP levels were not predictive of true APN in patients experiencing their first episode of a UTI using MLRA, although CRP was found to be significant by univariate analysis (CRP cutoff value, ≥3 mg/dL). They reported that a therapeutic delay time ≥48 h, therapeutic response time ≥24 h, axillary temperature ≥39℃, leukocyte count ≥13500/mm 3 , and age ≥18 months were predictors of true APN.…”

Section: Discussionmentioning

confidence: 93%

Prediction of Cortical Defect Using C-Reactive Protein and Urine Sodium to Potassium Ratio in Infants with Febrile Urinary Tract Infection

Jung

Lee

2016

Yonsei Med J

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PurposeWe investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI).Materials and MethodsWe examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed.ResultsCRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN.ConclusionWe conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.

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“…Although there are no further previous data on the effect of FAT on repeat DMSA and the formation and severity of permanent renal lesions, there are three studies on acute DMSA findings. According to Fernández-Menéndez et al and Ansari Gilani et al , children with abnormal acute phase DMSA were found to have an average FAT of 29.7 and 47.4 hours, respectively 9 10. Furthermore, when FAT was delayed by >24 hours, renal lesions in the acute DMSA were more common.…”

Section: Discussionmentioning

confidence: 98%

“…The importance of the duration of fever before treatment initiation (FBT) has been previously studied with controversial results 2 5 7–15. However, it is generally accepted that delaying treatment for over 48 or 72 hours can lead to acute renal lesions and consequent permanent renal lesions based on DMSA scintigraphy findings 9 10 13 15…”

Section: Introductionmentioning

confidence: 99%

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Fever duration during treated urinary tract infections and development of permanent renal lesions

et al. 2018

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ObjectiveTo assess the effect of the duration of fever after the initiation of treatment (FAT) of febrile urinary tract infections (UTI) on the development of permanent renal lesions based on dimercaptosuccinic acid (DMSA) scintigraphy findings. To evaluate the FAT contribution to permanent renal lesion formation in relation to fever before treatment initiation (FBT), the presence of vesicourinary reflux (VUR), age and severity of infection.MethodsThe inpatient records of 148 children (median age: 2.4 months (11 days to 24 months)) with a first episode of UTI during a 3-year period were analysed. DMSA findings, and clinical and laboratory parameters were evaluated.ResultsAmong the study population, 34/148 (22.97%) children had permanent renal lesions on the DMSA scan 6 months after a single episode of UTI. Twenty-three children (15.5%) had mild, 10 (6.7%) had moderate and 1 (0.6%) child had severe lesions on the DMSA. FAT prolongation >/48 hours was associated with older age (p=0.01) and increased absolute neutrophil count (p=0.042). The likelihood of lesions was significantly increased when FAT was ≥48 hours (R2=0.043, p=0.021). On multiple regression analysis, with the addition of FBT>/72 hours (0.022), the presence of VUR (p<0.001), C-reactive protein (p=0.027) and age (p=0.031), the effect of FAT on lesion development disappeared (p=0.15).ConclusionsProlongation of FAT≥48 hours of febrile UTI in children <2 years significantly contributes to the development of permanent renal lesions. However, delay in treatment initiation >/72 hours, the presence of VUR, older age and infection severity seem to be more significant predictors of the development of renal lesions.

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

Cited by 22 publications

References 23 publications

Serum neutrophil gelatinase-associated lipocalin for predicting acute pyelonephritis in infants with urinary tract infection

Serum neutrophil gelatinase-associated lipocalin for predicting acute pyelonephritis in infants with urinary tract infection

Prediction of Cortical Defect Using C-Reactive Protein and Urine Sodium to Potassium Ratio in Infants with Febrile Urinary Tract Infection

Fever duration during treated urinary tract infections and development of permanent renal lesions

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