Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection

Abstract

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). The medical records of 148 children (median age: 2.4months, range: 11days-24months), 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. 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)≥18000/μL (OR 2.4), absolute neutrophil count (ANC)≥9300/μL (OR 4.4), C-reactive protein (CRP)≥50mg/L (OR 2.7) and procalcitonin (PCT)≥1.64ng/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. 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.