Procalcitonin as a predictor of renal scarring in infants and young children

Abstract

The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

“…Our results show a signifi cant positive correlation between PCT level and WBC count, and CRP which is in accordance with the results of other similar studies [25][26][27][28]31,33,34] One of the strengths of the current study is that the time from the beginning of the infectious signs and measurement of PCT level was taken into account, and this might have reduced the bias in the results, in contrary to other cited studies [25][26][27][28]31,32], where authors admitted that one of the limitations of their studies is that they did not measure the time between onset of infection and collection of PCT samples and consequently, underestimated the relationship between high-grade VUR and PCT, and thus overestimated the number of children who were thought to have high-grade VUR, because this marker increases from the sixth hour after the beginning of the infectious process and decreases as quickly at the end.…”

“…The association of PCT values with VUR in children with febrile UTI remains controversial [25][26][27][28] The current study shows a signifi cant difference in PCT values between children with and without VUR, in accordance to the previously published data [25][26][27][28][31][32][33][34] . An earlier multicenter study of 398 patients in 8 centers in 7 European countries, in which DMSA was not performed in all patients [26] and strongly showed that PCT is a predictor of VUR independently of its relationship with early parenchymal involvement regardless of the urine-collection technique used for the diagnosis of UTI.…”

“…This association was assumed to be due to the increased risk of renal scarring with high-grade VUR is increased. While, Bressan and colleagues [34], found a signifi cantly higher level of procalcitonin in patients with VUR, but they did not show any correlation between serum procalcitonin level and the grade of VUR.…”

Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy

“…[9][10][11] So, PCT has been particularly studied during acute febrile urinary tract infection (UTI) and many papers have shown its correlation with pyelonephritis, RS and VUR although the exact place of this biomarker in clinical practice is not yet defined. [12][13][14][15] On the other hand, despite the lack of infection, higher CRP and PCT concentrations have been reported in CKD patients representing an ongoing inflammation in uremic milieu. [16][17][18][19][20] Based upon the putative role of inflammation in nephropathic pathway, in the present study we aimed to evaluate CRP, PCT and IL-18 levels in the absence of UTI episode in children with VUR who are at high risk for RN and CKD.…”

Isolation and Molecular Characterization of Bacteria From Urinary Tract Infections

“…Further identification was done using standard biochemical tests (IMVIC) including Urease, Catalase, Oxidase, H 2 S and sugar fermentations. [19] …”