Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection.
OBJECTIVE
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.
Kotoula
Aggeliki
A
Department of Pediatrics, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, Alexandroupolis, Greece.
Gardikis
Stefanos
S
Tsalkidis
Aggelos
A
Mantadakis
Elpis
E
Zissimopoulos
Athanassios
A
Deftereos
Savvas
S
Tripsianis
Gregorios
G
Manolas
Konstantinos
K
Chatzimichael
Athanassios
A
Vaos
George
G
D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009393:Nephritis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D014552:Urinary Tract Infections / Q000097:blood* / Q000150:complications
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide