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UROSCAN
Year : 2006  |  Volume : 22  |  Issue : 2  |  Page : 162-163
 

Procalcitonin: A marker of renal parenchymal infection in children?


Department of Urology, Christian Medical College, Vellore, India

Correspondence Address:
J C Singh
Department of Urology, Christian Medical College, Vellore
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Singh J C, Kekre N S. Procalcitonin: A marker of renal parenchymal infection in children?. Indian J Urol 2006;22:162-3

How to cite this URL:
Singh J C, Kekre N S. Procalcitonin: A marker of renal parenchymal infection in children?. Indian J Urol [serial online] 2006 [cited 2019 Jun 18];22:162-3. Available from: http://www.indianjurol.com/text.asp?2006/22/2/162/26582

Pecile P, Miorin E, Romanello C, Falleti E, Valent F, Giacomuzzi F, Tenore A. Procalcitonin: A marker of severity of acute pyelonephritis among children. Pediatr 2004;114:e249-54.


The distinction between acute pyelonephritis and UTI without renal parenchymal involvement is not easy among children, because of common clinical findings and nonspecific laboratory parameters. This paper[1] evaluated the role of Procalcitonin (PCT), a new marker of infection in diagnosing renal involvement during febrile UTI and in predicting subsequent scars, as assessed with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.

This prospective study included 100 children (69 girls and 31 boys), 1 month to 13 years of age with the first episode of febrile UTI. All patients had clinical features suggestive of UTI and a positive urine culture. Estimation of white blood cell count, CRP level, erythrocyte sedimentation rate (ESR) and PCT were done. Quantitative measurement of PCT levels was performed with an immunoluminometric assay and a value of 0.8 ng/mL was considered abnormal. Renal DMSA scintigraphy was performed within the first 5 days after admission, for all children. If the first scintigraphic result was abnormal, then a repeat examination was planned 6 months after the initial study, to assess the presence of permanent renal lesions or scars. Based on the scintigraphy findings, the children were divided into two groups, Group I with low (47%) and Group II with significant (53%) risk of scar formation. Though the mean PCT, CRP and ESR were significantly higher for group II than for group I, the specificity of PCT was 93.6% unlike that of CRP, which was only 31.9%. Positive and negative predictive values for renal involvement with PCT measurements were 93.7 and 83% and those with CRP measurements were 61.4 and 83.3%, respectively. Though both PCT and CRP had significant correlation with the severity of parenchymal infection, a significant correlation with scarring on follow up scans was seen only with PCT ( P =0.428).

The differentiation between lower UTI and renal parenchymal infection is crucial and we are still looking for predictors of renal damage in children with UTIs.[2] Though DMSA scintigraphy is very sensitive in the evaluation of renal parenchymal involvement in acute UTI,[3] availability of a less expensive and simpler investigation with comparable specificity and positive predictive value has distinct advantages. Moreover, DMSA may not differentiate old scarring from acute renal involvement, unless follow-up scanning is performed and there is a risk of exposure to radiation. In this study, PCT was found to be more specific and to have better positive predictive value to diagnose acute pyelonephritis.[1] Findings in a similar study with lesser sample size have been consistent.[4] Gurgoze et al[5] observed that serum PCT and other serum proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) levels were significantly elevated in those with acute pyelonephritis, than those with lower UTI. PCT has been found to differentiate systemic inflammatory response syndrome (SIRS) from sepsis in critically ill pediatric patients.[6] If consistent findings are observed in larger studies with long term follow up, PCT may find a role in differentiating pyelonephritis from lower UTI, thus altering management algorithm.

 
   References Top

1.Pecile P, Miorin E, Romanello C, Falleti E, Valent F, Giacomuzzi F, et al . Procalcitonin: A marker of severity of acute pyelonephritis among children. Pediatrics 2004;114:e249-54.   Back to cited text no. 1    
2.Canning DA. Procalcitonin: A marker of severity of acute pyelonephritis among children. J Urol 2005;174:2371.  Back to cited text no. 2    
3.Practice parameter: The diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics 1999;103:843-52.  Back to cited text no. 3    
4.Bigot S, Leblond P, Foucher C, Hue V, D'Herbomez M, Foulard M. Usefulness of procalcitonin for the diagnosis of acute pyelonephritis in children. Arch Pediatr 2005;12:1075-80.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Gurgoze MK, Akarsu S, Yilmaz E, Godekmerdan A, Akca Z, Ciftci I, et al . Pro inflammatory cytokines and pro calcitonin in children with acute pyelonephritis. Pediatr Nephrol 2005;20:1445-8.  Back to cited text no. 5    
6.Arkader R, Troster EJ, Lopes MR, Junior RR, Carcillo J, Leoni C, et al . Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome. Arch Dis Child 2005;91:117-20.  Back to cited text no. 6    




 

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