title: Procalcitonin as a predictor of renal scarring in infants and young children.
abstract: The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.
authors.affiliation: Department of Pediatrics, University of Padua, Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.forename: Barbara
authors.initials: B
authors.lastname: Andreola
authors.forename: Pietro
authors.initials: P
authors.lastname: Zucchetta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
authors.forename: Marta
authors.initials: M
authors.lastname: Burei
authors.forename: Giorgio
authors.initials: G
authors.lastname: Perilongo
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D011704:Pyelonephritis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D012372:ROC Curve; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D004113:Succimer; D013997:Time Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D004113:Succimer; D015740:Calcitonin Gene-Related Peptide