The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection

Abstract

Objective:To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI).Patients and methods:This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment.Results:UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p<0.01). Similarly, serum CRP was more significantly higher in patients with APN than in children with LUTI (19.7±9.1μg/mL vs. 5.5±2.3μg/mL (p<0.01). IL-6 levels >20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (P<0.001). Renal volume between 120-130% of normal was the best for differentiating APN from LUTI.Conclusions:RUS and urinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable.

Adiponectin alleviated renal cell apoptosis and inflammation via inactivation of JAK2/STAT3 signal pathway in an acute pyelonephritis mouse model

“…It's reported in previous studies that IL-6 as an important diagnostics biomarker contributes to differentiating between lower UTIs and pyelonephritis (39). In addition, serum IL-6 has shown high sensitivity and specificity in the diagnosis of pyelonephritis (40,41). TNF-α is an inflammatory cytokine produced by macrophages/monocytes during acute inflammation and is an important mediator of the inflammatory response in serious bacterial infections (42).…”

Macrophage Secretory Function among Urinary Tract Infection Patients before and after Ciprofloxacin Treatment: A Prospective Study

“…22 Elevation of IL-6 was associated with bacteriuria or acute cystitis. 23 Azab et al 24 showed that the concentration of IL-6 in urine could be used in the differentiation between acute pyelonephritis and lower tract infection. Moreover, it can be used as a marker of therapeutic response; normalization of urinary IL-6 levels is associated with the process of recovery from the infection.…”

Serum Interleukin-6 and Interleukin-8 are Sensitive Markers for Early Detection of Pyelonephritis and Its Prevention to Progression to Chronic Kidney Disease

“…The decision to choose IL-8 and IL-6 in this study was based on their specific bioactivity characteristics in response to inflammation of both white blood cells and the epithelial cells of the urinary tract. [ 13 14 15 16 17 ]…”

“…Of these biomarkers, serum and urine interleukin 6 (IL-6) and interleukin 8 (IL-8) are shown to be more specific and sensitive markers of inflammation and early detection of acute pyelonephritis. [ 14 15 16 17 ]…”