title: Diagnostic significance of clinical and laboratory findings to localize site of urinary infection.
abstract: The aim of this study was to define in children younger than 2 years of age the diagnostic significance of clinical and laboratory findings to localize site of febrile urinary tract infection. We reviewed the records of 185 children younger than 2 years of age admitted to hospital with febrile urinary tract infection. Patients were divided into having either acute pyelonephritis or acute cystitis according to the presence or absence of acute lesions on dimercaptosuccinic acid (DMSA) renal scintigraphy. Clinical and laboratory [white blood cell count (WBC), urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] findings were compared between the two groups using Student's t test, chi-square test, and multivariate analysis. Patients with pyelonephritis had statistically significant higher age, WBC, ESR, and CRP than those with cystitis. Although the sensitivity of the tests was 80-100%, their specificity was <28%. On multivariate analysis, 33% of patients with cystitis were diagnosed as having pyelonephritis, whereas 22% of those with pyelonephritis were considered to have cystitis. Given the low specificity of clinical findings and available laboratory tests to define the site of urine infection in this age group, we recommend DMSA renal scintigram as the test of choice to make the diagnosis of acute pyelonephritis in these patients.
authors: Department of Pediatrics, University of Florida, P.O. Box 100296, Gainesville, FL, 32610, USA. garineh@peds.ufl.edu
authors: Eduardo H
authors: EH
authors: Garin
authors: Fernando
authors: F
authors: Olavarria
authors: Carlos
authors: C
authors: Araya
authors: Monica
authors: M
authors: Broussain
authors: Claudia
authors: C
authors: Barrera
authors: Linda
authors: L
authors: Young
mesh_terms: D000208:Acute Disease; D001799:Blood Sedimentation; D002097:C-Reactive Protein; D002675:Child, Preschool; D003556:Cystitis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D011704:Pyelonephritis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D011866:Radioisotope Renography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002097:C-Reactive Protein