Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis

Gürgöze, Metin Kaya; Akarsu, Saadet; Yı́lmaz, Erdal; Gödekmerdan, Ahmet; Akça, Zehra; Ciftci, Ismail; Aygün, A. Denizmen

doi:10.1007/s00467-005-1941-6

Cited by 96 publications

(123 citation statements)

References 21 publications

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“…TNF-α was the other evaluated inflammatory mediator of serious bacterial infections in this study, as it is a rapid and reliable test for the diagnosis of upper UTIs (3,19) and is decreased following antibiotic treatment (20) However, TNF-α levels showed no significant changes in Lin's study (18) which is similar to our results.…”

Section: Discussionsupporting

confidence: 83%

“…Urine culture testing is the gold standard for the diagnosis of UTI, but requires 2 -3 days for the identification of the responsible organism, with false-positive and false-negative results. In addition, urinalysis and inflammatory markers, such as fever, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), have limited sensitivity and specificity for the diagnosis of acute pyelonephritis (APN) (2)(3)(4). The DMSA renal scan is another option for the diagnosis of APN, with positive findings in 50% of patients with a febrile UTI, and it has been recently recommended for the evaluation of renal damage 3 -6 months following an acute febrile UTI (5).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation and Comparison of Urinary Cytokines for the Diagnosis of Acute Pyelonephritis

Nickavar

Safaeian

Valavi

2016

Arch Pediatr Infect Dis

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Background: The accurate diagnosis and management of febrile urinary tract infection (UTI) is a clinical challenge in the absence of specific clinical and laboratory findings in infants and young children. Objectives: The aim of this study was to identify and compare the diagnostic and therapeutic implications of recently introduced cytokines for the diagnosis of acute pyelonephritis (APN). Methods: This multicenter prospective study was performed on 37 (female/male = 6.5:1) children with symptomatic culture-proven APN and 37 (female/male = 1.6/1) age-matched febrile children without UTIs as the control group. Urine samples were obtained before antibiotic treatment in both groups and 3 -4 days after treatment in the UTI group, and evaluated for interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-α (TNFα), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) using an ELISA immunoassay kit. Results: Mean urinary IL-1α, IL-4, IL-6, and IL-8 concentrations significantly increased in the acute phase of APN compared to the control group, and decreased following antibiotic treatment. Conclusions: We recommend routine urinalysis and urine culture for the diagnosis of children with APN. Urinary IL-4 was a relatively good cytokine for the prediction and treatment-monitoring of children with acute febrile UTI.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Evaluation and Comparison of Urinary Cytokines for the Diagnosis of Acute Pyelonephritis

Nickavar

Safaeian

Valavi

2016

Arch Pediatr Infect Dis

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“…No alternative as reference standard was available. Test positivity cut-offs or result categories of the index test were chosen based on literature review (12)(13)(14)(15)(16)(17)(21)(22)(23). Clinical information and reference standard results were not available to the performers/readers of the index test, and also clinical information and index test results were not available to the assessors of the reference standard.…”

Section: Test Methodsmentioning

confidence: 99%

“…Early diagnosis and aggressive treatment of APN can prevent or diminish renal scarring following febrile UTI in the childhood period (9)(10)(11). Serologic markers such as ESR, CRP, white blood cell (WBC) count are traditional markers that are commonly used for the diagnosis of pyelonephritis (12)(13)(14) but cannot reliably differentiate APN from cystitis. The first one is characterized by renal parenchymal involvement and the latter without it (13).…”

Section: Introductionmentioning

confidence: 99%

“…Serologic markers such as ESR, CRP, white blood cell (WBC) count are traditional markers that are commonly used for the diagnosis of pyelonephritis (12)(13)(14) but cannot reliably differentiate APN from cystitis. The first one is characterized by renal parenchymal involvement and the latter without it (13). Another study showed that ESR and differential leukocyte count are valuable tests for defining the localization of UTI level (14).…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Renal Cortical Involvement Using Serum and Urinary Inflammatory Markers in Children with Febrile Urinary Tract Infection

2017

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Background: Erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), urinary β2 microglobulin, antibody-coated bacteria in the urine sediment, and urinary lactic dehydrogenase (LDH) are more traditional tests used to diagnose true pyelonephritis. Acute-phase dimercaptosuccinic acid (DMSA) scan is a sensitive method for diagnosis of true pyelonephritis. Objectives:Defining predictive values of traditional inflammatory serologic parameters, urine analysis indexes, kidney ultrasonography and fever in children with febrile urinary tract infection for predicting renal cortical involvement. Patients and Methods:In a prospective study, 20 children admitted due to febrile urinary tract infection were assessed for renal cortical involvement by Technetium-99 m-labeled dimercapto succinic acid (TC99-DMSA) scan. Body temperature ≥ 39C, white blood cell count ≥ 15000 cell/µL, positive C-reactive protein, erythrocyte sedimentation rate (first hour) ≥ 30 mm/h, presence of proteinuria, severe pyuria or bacteriuria on urine analysis, urine specific gravity ≤ 1010, and renal ultrasonography were used for predicting renal cortical involvement. Sensitivity, specificity, positive and negative predictive values of these variables were measured by specific formula. Results:The highest measured sensitivity was 100% (erythrocyte sedimentation rate ≥ 30 mm/h). Urine specific gravity < 1010 and bacteriuria had the highest (75%) and lowest (20%) specificities respectively. The highest and lowest positive predictive values were 85.7% ( urine specific gravity < 1010) and 57% (proteinuria), whereas the highest and lowest negative predictive values were related to erythrocyte sedimentation rate > 30 mm/h (100%) and proteinuria (11%) respectively. Normal sonography had a low sensitivity for predicting absence of renal involvement (23%). Conclusions:Erythrocyte sedimentation rate ≥ 30 mm/h is a sensitive marker with high negative predictive value for predicting renal involvement in febrile urinary tract infection.

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Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Shaikh

Borrell

Evron

et al. 2015

Cochrane Database of Systematic Reviews

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BackgroundIn children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately di erentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. ObjectivesThe objectives of this review were to 1) determine whether procalcitonin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. Search methodsWe searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. Selection criteriaWe only considered published studies that evaluated the results of an index test (procalcitonin, CRP, ESR) against the results of an acutephase DMSA scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cuto values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/h for ESR. Data collection and analysisTwo authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-e ects pooled sensitivity and specificity values. Main resultsA total of 24 studies met our inclusion criteria. Seventeen studies provided data for the primary analysis: six studies (434 children) included data on procalcitonin, 13 studies (1638 children) included data on CRP, and six studies (1737 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the procalcitonin, CRP, ESR tests at the aforementioned Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children (Review)

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Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis

Cited by 96 publications

References 21 publications

Evaluation and Comparison of Urinary Cytokines for the Diagnosis of Acute Pyelonephritis

Evaluation and Comparison of Urinary Cytokines for the Diagnosis of Acute Pyelonephritis

Prediction of Renal Cortical Involvement Using Serum and Urinary Inflammatory Markers in Children with Febrile Urinary Tract Infection

Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

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