Comparative Efficacies of Procalcitonin and Conventional Inflammatory Markers for Prediction of Renal Parenchymal Inflammation in Pediatric First Urinary Tract Infection

• Published in: Urology (Ridgewood, N.J.) N.J.), 2009-04, Vol.73 (4), p.782-786
• Main Authors: Kotoula, Aggeliki, Gardikis, Stefanos, Tsalkidis, Aggelos, Mantadakis, Elpis, Zissimopoulos, Athanassios, Deftereos, Savvas, Tripsianis, Gregorios, Manolas, Konstantinos, Chatzimichael, Athanassios, Vaos, George
• Format: Article
• Language: English
• Subjects: Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Blood Sedimentation; C-Reactive Protein - analysis; Calcitonin - blood; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Human bacterial diseases; Humans; Infant; Infectious diseases; Leukocyte Count; Male; Medical sciences; Nephritis - blood; Nephritis - diagnosis; Nephritis - etiology; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prospective Studies; Protein Precursors - blood; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract Infections - blood; Urinary Tract Infections - complications; Urinary tract. Prostate gland; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.10.042

Objectives To compare the reliability of procalcitonin (PCT) with conventional laboratory parameters in predicting for renal parenchymal inflammation (RPI). Methods The study cohort consisted of 57 children who were admitted for a first-episode urinary tract infection. All patients underwent measurement of the leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT. RPI was evaluated by technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. If the first DMSA findings were abnormal, another analysis was performed 6 months later. The cutoff points for ESR, CRP, and PCT were established by comparing the areas under their receiver operating characteristic curves. Statistical analysis was performed using 1-way analysis of variance. Results Of the 57 children, 27 were diagnosed with RPI on the basis of positive DMSA results. The ESR, CRP, and PCT levels were significantly greater ( P < .001) in the patients with RPI than in those without RPI. In contrast, the leukocyte count was the same in both groups ( P > .05). PCT was a more sensitive and specific marker for differentiating upper and lower urinary tract infection than ESR and CRP. Persistent lesions at the site of previous RPI were found in 12 patients in the follow-up DMSA analysis, with total regression evident in the remaining 15. The PCT levels were significantly greater in those with persistent renal lesions than in those with total regression ( P = .005). Conclusions Serum PCT is a more reliable biologic marker than the ESR, CRP, or leukocyte count for the early prediction of RPI in children with a first episode of urinary tract infection. In addition, the greater the elevation of PCT at admission, the more positive the correlation for subsequent permanent renal damage.