Procalcitonin Is a Marker of Severity of Renal Lesions in Pyelonephritis

Benador, Nadine; Siegrist, Claire‐Anne; Gendrel, D.; Greder, Catherine; Benador, Daivy; Assicot, M.; Bohuon, C; Girardin, Éric

doi:10.1542/peds.102.6.1422

Cited by 133 publications

(95 citation statements)

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“…25 In febrile UTI, a high PCT concentration is a validated predictor of acute pyelonephritis 26 (confirmed by early renal scintigraphy) and for late renal scars. 18,19 The association between high PCT and VUR, especially high-grade VUR, could be explained by the risk for renal scarring that also increases with the VUR grade. 20 In our retrospective study, 10 (6%) patients were lost to follow-up before voiding cystourethrography could be performed.…”

Section: Discussionmentioning

confidence: 99%

“…6,15 The PCT threshold of 0.5 ng/mL was used to dichotomize the variable. It was the same as that applied in previous studies on PCT as a predictor of renal scarring, 18,26 and it is the lower limit of PCT in the semiquantitative doctor's bedside test. 28 …”

Section: Discussionmentioning

confidence: 99%

“…16 Thus, new predictors of VUR after a first febrile UTI are needed to define selective approaches for voiding cystourethrography. Procalcitonin (PCT), a recently identified marker of inflammation, 17 is a candidate because it was shown to be associated with renal scars, 18,19 which are correlated with VUR. 20 The aim of the present study was to analyze the relationship between PCT and VUR at the first febrile UTI in children.…”

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confidence: 99%

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Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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ABSTRACT. Objective. A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its relationship with vesicoureteral reflux.Methods. A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed.Results. Among 136 patients included, 25% had vesicoureteral reflux. The median procalcitonin concentration was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (>0.5 ng/mL) was associated with reflux (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 1.6 -16.2). After logisticregression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7-14.0). The relationship was stronger for high-grade (>3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivities were 85% (95% CI: 70 -94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54).Conclusion. High procalcitonin is a strong and independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography. U rinary tract infection (UTI) is one of the most frequent bacterial infections in children. 1 It has been estimated that 7% of girls and 2% of boys will have a UTI before 6 years of age. 2 Vesicoureteral reflux (VUR) is diagnosed at the time of the first febrile UTI in 20% to 40% of children. 3 VUR is a risk factor for relapsing UTI, renal scarring, hypertension, and renal failure. 3 Thus, pediatric societies 4-6 have recommended systematic voiding cystourethrography after the first febrile UTI in children. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, this procedure has been associated with a risk for iatrogenic UTI 7 and is irradiating, particularly for gonads, 8 painful, 9 and expensive. 10 Therefore, it would be useful to be able to predict the absence of VUR so as to avoid unnecessary voiding cystourethrography. 8 Two predictive tools have been proposed to define selective approaches for voiding cystourethrography. Renal ultrasonography alone, regardless of the criteria chosen, was shown to be poorly sensitive for VUR prediction. 11-14 A highly sensitive VUR risk score, combining clinical, biological, and radiologic variables, was also proposed, 15 but we have shown that this score was poorly reproducible. 16 Thus, new predictors of VUR afte...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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“…CRP and PCT were commonly used in this area particularly at the time of acute infection. [37][38][39][40][41] Unlike the reports above, we studied inflammatory markers at UTI free period to evaluate whether the inflammatory process continued independent from infection. However, we found these markers were in normal ranges and not associated either with RS or VUR grade.…”

Section: Discussionmentioning

confidence: 99%

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

2013

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Background: Some patients with vesicoureteral reflux (VUR) develop reflux nephropathy (RN) and a number of them progress to chronic kidney disease (CKD). However, it is unclear to predict which patient will develop RN and/or CKD. The aim of this study is to evaluate the role of Interleukin-18 (IL-18), C-reactive protein (CRP) and procalcitonin (PCT) as an indicator of RN in VUR. Methods: Ninety-three children aged 3.5-16 years with primary VUR were enrolled. Patients were divided into two groups according to the presence of renal scarring (RS). CRP, PCT, blood urea nitrogen (BUN), serum creatinine (Scr), urinary protein (Up), creatinine (Ucr) and microalbumin (Umalb), serum and urine IL-18 levels were determined during urinary tract infection (UTI) free episode. Results: BUN, Scr, Up/Ucr and Umalb/Ucr concentrations were higher whereas calculated creatinine clearance (Ccr) values were lower in RS (þ) group compared to RS (À) group. CRP, PCT, serum and urine IL-18 levels and mean urine IL-18/Cr concentrations were similar in both groups. Serum and urine IL-18 levels did not differ according to the grade of VUR. No significant correlation was found between CRP, PCT and IL-18. Conclusions: Proteinuria and microalbuminuria are valuable hallmarks of RN. CRP and PCT seem not to be reliable indicators of RN in VUR patients. Moreover, serum and urine IL-18 might not predict RN.

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“…In a prospective study of 80 children aged 1 month to 16 years of age, a group of investigators compared the procalcitonin level, CRP level and white blood cell count in children with pyelonephritis and lower UTI (38). There were statistically significant differences between the pyelonephritis and lower UTI groups for all 3 parameters; but only procalcitonin had a good correlation with increasing severity of changes noted on DMSA scan.…”

Section: Procalcitoninmentioning

confidence: 99%

Urinary Tract Infection in Children: Diagnostic and Prognostic Utility of Biomarkers

Uwaezuoke

2017

J Compr Ped

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In the diagnostic evaluation of urinary tract infection (UTI) in children, dipstick urinalysis and urine microscopy/culture are the initial steps. Although these investigations are not without their drawbacks, urine culture remains the gold standard. Biomarkers may also be used as diagnostic tools, predictors of complications, and renal parenchymal injury. This paper aims to review the studies reporting the utility of biomarkers in the diagnosis and prognostication of UTI. Using the key words-'urinary tract infection', 'children', and 'biomarkers'-the PubMed database was searched for systematic reviews/meta-analyses and original studies, which were published within the past 25 years. Information was also gathered from relevant textbooks published within the same period. Serum procalcitonin, urine/serum interleukin 6 (IL-6) and 8 (IL-8), as well as urine neutrophil gelatinase-associated lipocalin (NGAL) are the major biomarkers of febrile UTI. In addition, procalcitonin and these cytokines are reported to be early predictors of vesicoureteric reflux (VUR) and renal parenchymal injury, while procalcitonin and IL-6 can also help to differentiate between lower UTI and upper UTI (pyelonephritis). Despite the wide range in the sensitivity and specificity of these biomarkers reported in the reviewed studies, the values are still acceptable. Some of these biomarkers may, in the future, obviate the need for invasive radiological tests, although their utility still require validation by further research. However, given the ability of imaging studies to detect structural abnormalities of the urinary tract, their use still remains relevant in the investigation of UTI despite the radiation risks associated with majority of them.

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Procalcitonin Is a Marker of Severity of Renal Lesions in Pyelonephritis

Abstract: We conclude that serum PCT levels were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present and allowed for prediction of patients at risk of severe renal lesions.

Cited by 133 publications

References 23 publications

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

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

Urinary Tract Infection in Children: Diagnostic and Prognostic Utility of Biomarkers

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