Acute Pyelonephritis In Children Research Articles

КЛИНИЧЕСКИЕ «МАСКИ» ПИЕЛОНЕФРИТА У ДЕТЕЙ (СЛУЧАИ ИЗ ПРАКТИКИ)

Various variants of the clinical manifestation of the development of acute pyelonephritis in children are presented. Attention is drawn to the need for a detailed survey and examination of a sick child with suspected acute pyelonephritis. It is shown that laboratory diagnostics helps in making the speci-fied diagnosis and prescribing the necessary therapy. In differential diagnosis, it is important to under-stand the causes of the development of clinical manifestations of various diseases.

Adjuvant Corticosteroid Therapy During Acute Pyelonephritis in Children

Adjuvant Corticosteroid Therapy During Acute Pyelonephritis in Children

Nomogram for diagnosing acute pyelonephritis in pediatric urinary tract infection.

For risk stratification and individualized treatment for children with urinary tract infection (UTI), they must be assessed for the presence of acute pyelonephritis (APN). Our study aimed to combine variables that can predict APN and establish a nomogram for clinical use. In total, 111 children <5 years old hospitalized at Kaohsiung Veterans General Hospital for UTI were classified into APN and simple UTI groups based on a technetium-99m dimercaptosuccinic acid scan. Their demographic, laboratory test, and renal and urinary bladder sonography (RUBS) data were compared. Fever peak of >39°C, serum procalcitonin (PCT)≥0.52pg/mL, C-reactive protein (CRP)≥2.86mg/dL, and abnormal RUBS findings were independent variables for predicting APN in children. The nomogram established using the aforementioned variables had an area under the receiver operating characteristic curve (AUC) of 0.89, which was higher than those of PCT and CRP alone (0.776 and 0.774, respectively). The combination of four variables had the highest power in predicting APN in children with UTI. The established nomogram is practical for clinical use.

Features of the course of acute pyelonephritis in children with an experience of a new coronavirus infection (COVID-19)

Purpose. To determine the clinical and laboratory features of the course of acute pyelonephritis in children with a history of COVID-19 and to determine the risk of developing chronic kidney disease.Material and methods. The main cohort consisted of 36 patients with the debut of acute pyelonephritis, who had previously suffered COVID-19, the average age was 7,5 years. The comparison group included 47 patients with the onset of acute pyelonephritis and a normal level of IgG antibodies to SARS-CoV-2, the average age was 7,0 years. Laboratory tests included full blood count and urinalysis, blood biochemistry, procalcitonin, urine microalbumin, urine creatinine, Zimnitsky urine test, bacteriological urine test, glomerular filtration rate, coagulogram, and Lipocalin-2 associated with neutrophil gelatinase (NGAL) in the urine.Results. Patients with a history of COVID-19, at the onset of acute pyelonephritis, demonstrated a higher incidence of apostematous pyelonephritis, a higher degree of damage to the tubulointerstitial kidney tissue, a high frequency and a higher level of hematuria, proteinuria, hyperfiltration, hypostenuria, as well as a more significant increase in fibrinogen, CRP, procalcitonin, and uNGAL/Cr levels than children of the comparison group. It was shown that almost half of the children with acute pyelonephritis who had had COVID-19 retained urinary syndrome during examination 3–4 months after the onset of the disease.Conclusion. Thus, long-term effects of the SARS-CoV-2 virus on the renal parenchyma were confirmed, even in asymptomatic children. The high level of uNGAL/Cr in children with acute pyelonephritis who had had COVID-19, which was almost 8 times higher than in the comparison group, reflects more pronounced damage to the tubulointerstitial kidney tissue. The risk of developing chronic kidney disease in this group was 3,5 times higher.

Efficacy of corticosteroids in reducing the renal scarring in acute pyelonephritis in children

Abstract Background: Renal scarring is a serious and chronic consequence of acute pyelonephritis in children, which may cause late complications in young adults, such as hypertension, chronic renal failure, and preeclampsia. Urinary tract infection is the most common serious infection in childhood, accounts for 5% to 14% of all pediatric emergency centers. This study aimed to evaluate the effect of dexamethasone in reducing or preventing renal scarring in children who were treated with antibiotics for acute urinary tract infection. Methods: This is a multicenter, randomized, placebo-controlled, double-blind clinical trial, which evaluates the efficacy of dexamethasone in preventing or reducing renal scarring in febrile children (2 months to 14 years) with a first-diagnosed urinary tract infection. A total of 120 participants will be enrolled over a 3-year period from 6 sites in Qatar. Participants will be randomized into a therapy arm and a placebo arm; each arm will comprise 60 participants. Participants were allocated to the therapy arm and received dexamethasone, while those who were allocated to the placebo arm received a placebo, orally in the same regime, twice daily for 3 days. Blood and urine investigations will be performed at presentation and after 3 days from beginning antibiotics, renal ultrasonography will be performed over the first month and DMSA scan will be performed 6 months after enrolment. Study medication will be administered in the first 48 hours of starting antibiotics. The DMSA scan for all participants will be read by 3 reference radiologists without knowledge of clinical features or trial arms. Discussion: The formation of renal scarring will be compared between participants in both arms, the severity of renal scars and all adverse events of the therapy is determined. Trial registration: This trial has been registered at ClinicalTrials.gov: NCT04654507 (December 4, 2020), https://clinicaltrials.gov/ct2/show/NCT04654507.

Comparing Interleukin-6, C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count for the Early Diagnosis of Acute Pyelonephritis in Children

Background: Urinary tract infection (UTI) is common in children. Differentiating lower UTI from acute pyelonephritis (APN) is of great importance in children since early diagnosis and timely management can prevent kidney scarring and associated complications. Objectives: We aimed to compare the diagnostic performance of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count with interleukin-6 (IL-6) for the diagnosis of APN in children. Methods: This cross-sectional study included 38 children with APN (based on clinical findings and positive urine culture) aged 1 month to 15 years admitted to Bandar Abbas Pediatric Hospital, Bandar Abbas, Iran, during 2019-2020. Serum CRP, WBC, IL-6, and WBC count were measured in all children. Age and sex of the participants were also recorded. Results: The mean ± SD age of the children was 65.82±46.67 months, of whom 23 (60.5%) were girls. The sensitivity of WBC, ESR, CRP, and IL-6 for the early diagnosis of APN was 39.5%, 71.1%, 60.5%, and 71.1%, respectively. Taking the results of ESR, CRP, and WBC into account as the basis of diagnosis, altogether 9.98 pg/mL was the best cut-off of serum IL-6 for the diagnosis of APN with 70%-80% sensitivity and 56.5%-73.7% specificity. A significant correlation was found between serum IL-6 and CRP, ESR, and WBC with the strongest correlation between IL-6 and CRP (r=0.451, P=0.004). Age and sex did not affect these correlations. The sensitivity of serum IL-6 at the 5 pg/mL cut-off for the diagnosis of APN was higher in boys and children younger than 6 years. Conclusion: IL-6 can diagnose APN in children aged 1 month to 15 years with 71.1% sensitivity. Its sensitivity is superior to CRP and WBC and comparable with ESR in this regard.

Диагностическая роль радионуклидных методов исследования у больных пиелонефритом

Острые и хронические формы пиелонефрита (ПН) являются наиболее распространенными заболеваниями мочевой системы во всех возрастных группах. Частота встречаемости острого ПН у детей составляет 19,1 на 1000, хронического ПН — 5–12,5 на 1000. В работе на основании ретроспективного анализа рассмотрена диагностическая роль радионуклидных методов визуализации при остром и хроническом ПН. Радионуклидные методы исследования благодаря высокой чувствительности позволяют определить у больных ПН степень функционально-топографических изменений каждой почки — секреторную функцию и характер пассажа индикатора через чашечно-лоханочную систему и мочеточник. Радионуклидные методы исследования являются чувствительными и точными методами лучевой визуализации при ПН, а также надежными методами динамического мониторинга в послеоперационном наблюдении пациентов. Применение радионуклидных методов визуализации позволяет установить причину и последствия ПН и разработать рациональный план лечения.

Этиология и патогенез острых пиелонефритов у детей

Introduction. Acute pyelonephritis in children takes a leading place among the reasons for hospitalization. Objective. To study the epidemiological, anamnestic, diagnostic and clinical features of the course of pyelonephritis in children. Materials and methods. We have carried out a retrospective study of case histories of 142 children admitted to the urology department of the Emergency hospital №2 (Tomsk) with a diagnosis of acute pyelonephritis. Results. According to the results of our study, children of both sexes of young age (up to 1 year оf age) suffer from acute complicated pyelonephritis, whereas acute uncomplicated pyelonephritis is typical for girls over 3 years old. The sensitivity of ultrasound examination of the kidneys in acute pyelonephritis was 76.8%. The vast majority (96,8%) of acute uncomplicated pyelonephritis were caused by Escherichia coli. Escherichia coli was the cause of acute complicated pyelonephrities only in 30.8% of patients, Pseudomonas aeruginosa was ranked in second in frequency (15.4%), and Enteroccoccus faecalis was ranked third (11.5%). The following antibiotics retained their effectiveness among all the identified causative flora of uncomplicated pyelonephritis: fosfomycin, furagin, gentamicin, amikacin. Only amikacin showed absolute efficiency (100%) in the group of complicated pyelonephritis. 90% of bacteria showed sensitivity to fosfomycin, and 88.5% to cefepime and ertapenem. For children with acute pyelonephritis, the acute phase process of cytomegalovirus, Ebstein-Barr viral infections, previous herpes simplex virus infection, as well as contact with Chlamydia trachomatis, Ureaplasma urealуticum and Mycoplasma hominis are specific. Conclusion. The results of the study indicate the dynamics in the etiology and pathogenesis of acute pyelonephritis in children and a need for an annual monitoring in order to correct therapy.

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?

Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children.

In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. This is an update of a review first published in 2015. The objectives of this review were to 1) determine whether procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews through to 17th December 2019 for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. We only considered published studies that evaluated the results of an index test (PCT, CRP, ESR) against the results of an acute-phase 99Tc-dimercaptosuccinic acid (DMSA) scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cut-off values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/hour for ESR. Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. A total of 36 studies met our inclusion criteria. Twenty-five studies provided data for the primary analysis: 12 studies (1000 children) included data on PCT, 16 studies (1895 children) included data on CRP, and eight studies (1910 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the PCT, CRP, ESR tests at the aforementioned cut-offs were 0.81 (0.67 to 0.90), 0.93 (0.86 to 0.96), and 0.83 (0.71 to 0.91), respectively. The summary specificity values for PCT, CRP, and ESR tests at these cut-offs were 0.76 (0.66 to 0.84), 0.37 (0.24 to 0.53), and 0.57 (0.41 to 0.72), respectively. The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (< 20 mg/L) appears to be somewhat useful in ruling out pyelonephritis (decreasing the probability of pyelonephritis to < 20%), but unexplained heterogeneity in the data prevents us from making recommendations at this time. The procalcitonin test seems better suited for ruling in pyelonephritis, but the limited number of studies and the marked heterogeneity between studies prevents us from reaching definitive conclusions. Thus, at present, we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice.

Acute pyelonephritis in children and the risk of end-stage kidney disease.

Pyelonephritis is the most common serious bacterial infection during childhood. The long-term importance of kidney scarring is unclear. To assess the risk of end-stage kidney disease (ESKD) in adolescents and young adults with history of pyelonephritis. A nationwide, population-based, historical cohort study, including 1,509,902 persons (62% male) examined for military service between 1967 and 1997. Participants with a history of pyelonephritis were sub-grouped according to presence of kidney scarring and baseline kidney function. Data were linked to the Israeli ESKD registry to identify incident ESKD cases. Cox proportional hazards models were used to estimate the hazard ratio (HR) of treated ESKD (dialysis or kidney transplant). Pyelonephritis was diagnosed in 6979 participants (0.46%). 6479 had normal kidney function and no evidence of kidney scarring, 400 had normal kidney function with evidence of scarring, and 100 demonstrated reduced baseline kidney function. Treated ESKD developed in 2352 individuals (0.2%) without history of pyelonephritis, 58 individuals (0.9%) with normal kidney function, history of pyelonephritis and no kidney scarring, 14 individuals (3.5%) with normal kidney function, history of pyelonephritis and kidney scarring, and 23 individuals (23.0%) with history of pyelonephritis and reduced baseline kidney function, yielding HR of 3.3, 34.8 and 43.2, respectively, controlling for age, gender, paternal origin, enrollment year, body mass index, and blood pressure, and accounting for death as a competing risk. History of pyelonephritis was associated with significantly increased risk of treated ESKD, particularly when associated with kidney scarring or reduced baseline kidney function.

Serum Presepsin, Proadrenomedullin and Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) as Biomarkers for the Diagnosis of Acute Pyelonephritis

To investigate the diagnostic values of serum presepsin, proadrenomedullin (proADM) and triggering receptor expressed on myeloid cells-1 (TREM-1) levels in children with acute pyelonephritis and lower urinary tract infection. Peripheral venous blood and urine samples were obtained before starting antibiotic therapy at the time of admission in all patients. Serum TREM-1, presepsin and proADM concentrations were determined by the enzyme-linked immunosorbent assay method. 82 children (38 acute pyelonephritis, 24 lower urinary tract infection, 20 controls) were enrolled. Serum proADM and TREM-1 levels were higher in patients with acute pyelonephritis than those of lower urinary tract infection and controls (P=0.001 and P<0.001, respectively). Both serum proADM and TREM-1 levels had predictive value for diagnosis of acute pyelonephritis (P=0.006 and P<0.001, respectively). ROC analysis showed that proADM and TREM-1 had positive predictive values for diagnosis of acute pyelonephritis (AUC=0.830, P=0.003; and AUC=0.843, P<0.001, respectively). Serum proADM and TREM-1 levels could serve as early biomarkers for the diagnosis of acute pyelonephritis in children.

Diagnostic performance of contrast-enhanced ultrasound for acute pyelonephritis in children

The objective of our study was to evaluate the performance of renal contrast-enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter- and intra-observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children.

Comparison of Cohen and Lich-Gregoir ureteral reimplantation in the surgical management of primary unilateral vesicoureteral reflux in children.

Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Various intravesical and extravesical techniques have been described for the surgical correction of VUR. The aim of our study was to compare the results of open intravesical and extravesical procedures for unilateral primary VUR in children. Between January 2012 and August 2018, 38 children with primary VUR who underwent open ureteral reimplantation surgery were retrospectively reviewed. The Cohen (intravesical) and the Lich-Gregoir (extravesical) approach were grouped as groups A and B, respectively. The groups were compared for age, gender, preoperative reflux grade, presence of lower urinary tract symptoms, operation time, discomfort and pain, analgesic requirements, duration of hematuria, postoperative complications, and hospital stay. All the parameters were statistically compared. There were 38 patients in this study. Group A had 18 patients, and group B had 20 patients. The mean operative time was significantly shorter in group B than in group A. The mean hospital stay was also shorter in group B. The urethral foley stay period was 4.7±0.9 days 2±0 days (p = 0.000*), respectively, for group A and B. Macroscopic hematuria was seen in group A. The objective pain scale was worse after intravesical surgery. Analgesic requirements were higher in group A (p =0.131). Intravesical and extravesical ureteroneocystostomy methods are equally successful and feasible in the treatment of primary unilateral VUR. The Cohen technique is associated with a longer and more painful hospital stay, gross hematuria, and longer operative time, compared to the Lich-Gregoir technique.

Çocukluk Çağında Akut Piyelonefrite Neden Olan Mikroorganizmaların Antibiyotik Dirençlerinin Beş Yıl Ara ile Karşılaştırılması

Çocukluk Çağında Akut Piyelonefrite Neden Olan Mikroorganizmaların Antibiyotik Dirençlerinin Beş Yıl Ara ile Karşılaştırılması

Profile and Antibiotic Sensitivity of Acute Pyelonephritis in Children at Gabriel Toure Teaching Hospital, Bamako

Background: Very common symptom in children, fever, perhaps a warning sign of more or less severe pathology, rapidly progressive, including an invasive bacterial infection such as acute pyelonephritis (APN). The aim of this work was to study the bacteriological profile and antibiotic sensitivity of APN in children. Methods: A prospective study involving any infant or child aged 3 months to 15 years with an acute fever (≥38°C) in which a urine test strip was performed in the pediatric department of the teaching hospital Gabriel Toure between April 1st and May 15th, 2019 (45 days). Results: 124 children were included out of 244 febrile patients. Infants (3 - 23 months) predominated (52.8%) with a sex ratio of 2. Seventy-five percent of children came directly from home and 30.6% were on antibiotic prior to admission. The urine bag sample was taken in 55.6% and the urine was macroscopically cloudy in 32.3%. Stigmas of urinary tract infection at the urinary strip were present in 56.5%. Confirmation of acute pyelonephritis (APN) by CytoBacteriological Urine Examination (CBUE) was 29% with Escherichia coli (63.9%) or Enterococcus faecalis (30.5%). Sensitivity was excellent for ciprofloxacin and imipenem (100%). The overall resistance was greater for gentamicin, cotrimoxazole, ceftriaxone, cefotaxime and amoxicillin-clavulanic acid (Threshold: 17.9% - 95.6%). APN was associated with bacteremia in 2.8% with hospitalization for 45.2% and mortality of 11.1% (due to severe acute malnutrition, severe dehydration and multifocal infection). Conclusion: The APN, daily activity of pediatrician in Bamako, is observed in one third of febrile children associated with a major life-threatening condition of risk factors, then the likely antibiotherapy could be amikacin in our context.

Urinary Interleukin‐6 as biomarker for diagnosis of acute pyelonephritis in children

Introduction Urinary Interleukin-6 (IL-6) a pleiotropic cytokine with pro-inflammatory and immune-regulatory functions is a key mediator of inflammation in children with Urinary tract infection (UTI). Aim of the study The aim of this study is to estimate the role of urinary IL-6 (UIL-6) in diagnosis of acute UTI in children and its usefulness in differentiation between upper urinary tract infection (UUTI) (pyelonephritis) and lower urinary tract infection (LUTI) (cystitis). Patients & Methods This study conducted on a total 56 children divided into 36 patients suffering from UTI with mean age 4.3 ± 3.1 and 20 apparently healthy children age and sex matched with the cases. All patients were subjected to routine investigation and urine IL-6 assay. Results Urinary IL-6 was significantly higher in patients with UTI than control group, Sensitivity was 94.4 %, specificity of 92.1%, positive predictive value was 85%, negative predictive value was 97.2% anddiagnostic accuracy was 92.8% and the best cut off value >17 pg/ml. Also Urinary IL-6 was significantly higher in acute pyelonephritis (APN) in comparison to lower UTI cases and there was a positive correlation between urinary IL-6 level and fever, CRP, and leukocyte count [r = 0.623 P = 0.006, r = 0.816, P < 0.001 and r = 0.688, P < 0.002 respectively] Conclusion Urinary IL-6 level may considered as a reliable biochemical marker to determine the severity of renal injury in APN as well as outcome of pediatric patients

Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis.

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

Urinary excretion of pentraxin-3 correlates with the presence of renal scar following acute pyelonephritis in children.

Acute pyelonephritis is associated with considerable morbidity and potential for renal scarring. Pentraxin3 (PTX3) is a recently discovered mediator of inflammation. The objective of this study was to investigate the changes in serum and urine PTX3 levels in children who had a history of pyelonephritis and were diagnosed with renal parenchymal scar (RPS) and/or vesicoureteral reflux (VUR). The study included 88 children (31 males, 57 females) aged between 3months and 18years. The children included in the study were divided into four groups: VUR with RPS (Group 1), RPS without VUR (Group 2), VUR without RPS (Group 3), and healthy children without a history of hydronephrosis or UTI history (Group 4). After the initial evaluation, the participants were further divided into two more groups and re-evaluated: Children with RPS (Group 1 + 2), children without RPS (Group 3 + 4), children with VUR (Group 1 + 3), and children without VUR (Group 2 + 4). We found that urine pentraxin 3 (uPTX3) and uPTX3/Creatinine levels were significantly higher in the groups with renal scar with or without VUR than the ones without RPS [mean uPTX3, 3.5pg/ml (min-max 0.0022-12.3668) vs. 2.2pg/ml (min-max 0.0022-18.5868) and uPTX3/creatinine, 10.5pg/mg (min-max 0.0035-51.1) vs. 5.8pg/mg (min-max 0.0004-78.7), p < 0.01]. uPTX3 levels were not different among the groups with and without VUR. In addition, serum PTX3 levels were not different among the groups. We showed that urinary PTX3 increased only in patients with scarred kidneys. These results might be helpful to predict RPS due to past pyelonephritis.

Distinctive inflammatory profile between acute focal bacterial nephritis and acute pyelonephritis in children

BackgroundAcute focal bacterial nephritis (AFBN) is a severe form of upper urinary tract infection (UTI) with neurological manifestations and focal renal mass lesions on computed tomography (CT). Prolonged antibiotic therapy may improve the renal outcome, but the early differential diagnosis of AFBN from acute pyelonephritis (APN) is challenging. We searched for effective biomarkers of AFBN based on the pathophysiology of upper UTIs. MethodsOf 52 upper UTI cases treated at Yamaguchi University between 2009 and 2016, 38 pediatric patients with AFBN (n=17) or APN (n=21) who underwent ultrasonography and/or CT were enrolled. The clinical data and serum cytokine concentrations were analyzed to differentiate AFBN from APN. ResultsAFBN patients tended to be older, and have a higher body temperature, longer febrile period, more frequent neurological symptoms, higher immature neutrophil count, lower lymphocyte count, higher procalcitonin and urine β2-microglobulin levels. AFBN patients showed higher serum levels of IFN-γ, IL-6, IL-10 and soluble TNF-receptor 1 (sTNFR1) (all p<0.05). Although the cytokine levels were variably correlated among each other, multiple logistic regression analysis revealed that combination of IFN-γ and IL-6 levels were most relevant for distinguishing AFBN from APN. The discriminant power of the logistic equation was 0.86 in terms of the area under the curve by the ROC analysis. ConclusionsCirculating 4 out of 7 cytokines in AFBN patients were at higher levels compared with those in APN patients. IFN-γ and IL-6 levels might most effectively distinguish AFBN from APN.