title: The role of procalcitonin for acute pyelonephritis and subsequent renal scarring in infants and young children.
abstract: OBJECTIVE
  We assessed the usefulness of procalcitonin as a biological marker in diagnosing acute pyelonephritis and for predicting subsequent renal scarring in young children with a first febrile urinary tract infection.
  
  
  METHODS
  Children 2 years old or younger with a first febrile urinary tract infection were prospectively studied. Renal parenchymal involvement was assessed by (99m)Tc-dimercaptosuccinic acid scan within 5 days of admission and after 6 months. Serum samples from all patients were tested for procalcitonin, C-reactive protein and white blood cell count measurements.
  
  
  RESULTS
  The 112 enrolled patients (age range 24 days to 24 months old) were divided into acute pyelonephritis (76) and lower urinary tract infection (36) groups according to the results of (99m)Tc-dimercaptosuccinic acid scans. Median values of procalcitonin, C-reactive protein and white blood cell count at hospitalization were significantly higher in patients with acute pyelonephritis than in those with lower urinary tract infection. The area under receiver operating characteristic curves showed that procalcitonin was superior to C-reactive protein and white blood cell count as a marker for diagnosing acute pyelonephritis. Initial and post-antibiotic treatment procalcitonin values were significantly higher in children with renal scarring than in those without scarring (p <0.001). Procalcitonin values at hospitalization and after treatment were independent predictors of later renal scarring on logistic regression analysis.
  
  
  CONCLUSIONS
  Our results indicate the superior diagnostic accuracy of procalcitonin for predicting acute pyelonephritis in children 2 years old or younger. Higher initial and posttreatment procalcitonin values are independent risk factors for later renal scarring.
authors.affiliation: Department of Pediatrics and Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. cshy098@csh.org.tw
authors.forename: Ji-Nan
authors.initials: JN
authors.lastname: Sheu
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Chang
authors.forename: Shan-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Tung-Wei
authors.initials: TW
authors.lastname: Hung
authors.forename: Ko-Huang
authors.initials: KH
authors.lastname: Lue
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006023:Glycoproteins; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011498:Protein Precursors / Q000097:blood; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis*; D012372:ROC Curve; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide