title: A rapid plasma neutrophil gelatinase-associated lipocalin assay for diagnosis of acute pyelonephritis in infants with acute febrile urinary tract infections: a preliminary study.
abstract: In infants with febrile urinary tract infection (UTI), the accurate rapid diagnosis of acute pyelonephritis (APN) would be valuable because early aggressive treatment reduces the risk of renal scarring. The objective of the study was to evaluate whether rapid plasma neutrophil gelatinase-associated lipocalin (NGAL) assay could be used as a diagnostic biomarker of renal parenchymal injury in infants with acute febrile UTI to distinguish APN at the bedside. This prospective observational study included 47 infants, who were admitted with a first episode of acute febrile UTI. Total UTI group was divided into the Cortical defect (UTI-CD, n = 24) group and Non-cortical defect (UTI-ND, n = 23) group, according to the result of renal scan. For the Control group, 15 infants who presented a febrile episode without any focus of bacterial infection were included. On admission, the median NGAL level (106.5 [60-476] ng/mL) in the UTI-CD group was significantly higher than that (60 [60-196] ng/mL) in the UTI-ND group and that (60 [60-197] ng/mL) in the Control group and was significantly decreased to 60 [60-306] ng/mL after an antibiotic treatment. The area under the receiver operating characteristic curves was 0.748 (95 % CI, 0.610-0.887; P = 0.003) for NGAL levels and 0.724 (95 % CI, 0.579-0.868; P = 0.009) for CRP levels. The best cutoff of NGAL level for detection of APN was founded to be 61.0 ng/mL (sensitivity, 75.0 %; specificity, 78.3 %). Although not a stand-alone test, the rapid determination of plasma NGAL level provides valuable information quickly, concerning the distinction of APN, for determining the clinical course of acute febrile UTI.
authors.affiliation: Department of Pediatrics, Korea University College of Medicine, #516, Gojan-Dong, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 425-707, South Korea.
authors.forename: Won Hee
authors.initials: WH
authors.lastname: Seo
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Nam
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Lee
authors.forename: Bo-Kyung
authors.initials: BK
authors.lastname: Je
authors.forename: Hyung Eun
authors.initials: HE
authors.lastname: Yim
authors.forename: Byung Min
authors.initials: BM
authors.lastname: Choi
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis; D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007118:Immunoassay; D007223:Infant; D007672:Kidney Cortex / Q000503:physiopathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D011704:Pyelonephritis / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D012372:ROC Curve; D012016:Reference Values; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000097:blood* / Q000188:drug therapy
chemical_list: D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
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