AIM: 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.
Written by:
Koufadaki AM, Karavanaki KA, Soldatou A, Tsentidis Ch, Sourani MP, Sdogou T, Haliotis FA, Stefanidis CJ. Are you the author?
Second Department of Pediatrics, University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece.
Reference: Acta Paediatr. 2014 Sep;103(9):e404-9.
doi: 10.1111/apa.12706
PubMed Abstract
PMID: 24862642