title: Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection.
abstract: OBJECTIVE
  To evaluate the predictive value of various clinical and laboratory parameters on the identification of acute extensive and/or multifocal renal involvement in children with febrile urinary tract infections (UTI).
  
  
  METHODS
  The medical records of 148 children (median age: 2.4 months, range: 11 days-24 months), who were admitted during a 3-year period with a first episode of febrile UTI, were analysed. Acute dimercaptosuccinic acid scintigraphy (DMSA), clinical and laboratory parameters were evaluated.
  
  
  RESULTS
  Seventy six children (51%) had abnormal findings on the acute DMSA. Of them, 20 had DMSA grade 2, while 56 had grade 3 and 4. Patients with a DMSA grade 3 and 4 were more likely to have shivering (OR 3.4), white blood count (WBC) ≥ 18 000/μL (OR 2.4), absolute neutrophil count (ANC) ≥ 9300/μL (OR 4.4), C-reactive protein (CRP) ≥ 50 mg/L (OR 2.7) and procalcitonin (PCT) ≥ 1.64 ng/mL (OR diagnostic). There was a significant difference of WBC (p = 0.004), ANC, CRP and PCT levels (p < 0.001) between children with normal and grade 2 aDMSA versus those with aDMSA grade 3 and 4.
  
  
  CONCLUSIONS
  Shivering and elevated inflammatory markers increase the risk of acute extensive and/or multifocal kidney involvement in children with febrile UTI. Procalcitonin seems to be an excellent marker of the severity of acute parenchymal involvement.
authors.affiliation: Second Department of Pediatrics, University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: A M
authors.initials: AM
authors.lastname: Koufadaki
authors.forename: K A
authors.initials: KA
authors.lastname: Karavanaki
authors.forename: A
authors.initials: A
authors.lastname: Soldatou
authors.forename: Ch
authors.initials: Ch
authors.lastname: Tsentidis
authors.forename: M P
authors.initials: MP
authors.lastname: Sourani
authors.forename: T
authors.initials: T
authors.lastname: Sdogou
authors.forename: F A
authors.initials: FA
authors.lastname: Haliotis
authors.forename: C J
authors.initials: CJ
authors.lastname: Stefanidis
mesh_terms: D019411:Clinical Laboratory Techniques; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000175:diagnosis* / Q000382:microbiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000175:diagnosis*
keywords: Acute pyelonephritis; Indices; Renal lesions