title: The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection.
abstract: OBJECTIVE
  To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI).
  
  
  METHODS
  This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment.
  
  
  RESULTS
  UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p< 0.01). Similarly, serum CRP was more significantly higher in patients with APN than in children with LUTI (19.7±9.1μg/mL vs. 5.5±2.3μg/mL (p< 0.01). IL-6 levels >20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (P< 0.001). Renal volume between 120-130% of normal was the best for differentiating APN from LUTI.
  
  
  CONCLUSIONS
  RUS and urinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable.
authors: Department of Urology, Faculty of Medicine, October 6 University, Cairo, Egypt.
authors: Sherif
authors: S
authors: Azab
authors: Department of Pediatric, Cairo University, Cairo, Egypt.
authors: Mostafa
authors: M
authors: Zakaria
authors: Department of Clinical Pathology, National research Center, Cairo, Egypt.
authors: Mona
authors: M
authors: Raafat
authors: Department of Radiology, University Cairo, Cairo, Egypt.
authors: Hadeel
authors: H
authors: Seief
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000652:urine*; D007668:Kidney / Q000000981:diagnostic imaging*; D059411:Lower Urinary Tract Symptoms / Q000000981:diagnostic imaging; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000175:diagnosis*
chemical_list: D015850:Interleukin-6
keywords: ; Lower Urinary Tract Symptoms; Interleukin-6; Lower Urinary Tract Symptoms