Lower Urinary Tract Infection Group Research Articles

Determining the effectiveness of the immature granulocyte percentage and systemic immune-inflammation index in predicting acute pyelonephritis

ABSTRACT Aim The most serious form of urinary tract infection (UTI) is acute pyelonephritis (APN), which can result in bacteremia and renal scarring. This study aims to show the roles that the systemic immune-inflammation index (SII) and the immature granulocyte (IG) percentage play in predicting APN in pediatric patients by comparing them with traditional infection markers. By illustrating a significant relationship between APN, the IG percentage, and the SII, the study’s contributions to the differential diagnosis of UTI can promote a rapid and appropriate treatment of APN. Material and Methods The present study included 522 pediatric patients. The patients were divided into two groups: (I) an APN group (n = 236) and (II) a lower UTI group (n = 286). Results The mean age of the sample was 5.05 ± 4.7 years. According to the most appropriate cutoff values, the findings showed that among all the parameters, C-reactive protein (CRP) and the IG percentage had the highest sensitivities, specificities, and predictive values for predicting APN. Conclusion This study emphasizes the support features of the IG percentage and the SII in the diagnosis of APN in pediatric patients, a topic that has recently attracted attention. The findings indicated that among all of the parameters behind CRP, the IG percentage and the SII had the highest sensitivities, specificities, and predictive values for forecasting APN. It is worth noting that these methods can be applied without additional costs or burdens to the patient.

D-dimer as a marker of acute pyelonephritis in infants younger than 24months with urinary tract infection.

D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI). We retrospectively analyzed the data of 177 young infants (<2years) with febrile UTI between 2005 and 2014, grouped as APN and lower UTI groups. Conventional inflammatory markers (white blood cell count (WBC), erythrocyte sedimentation rates (ESR), C-reactive protein (CRP)), and D-dimer were measured. The WBC counts (P = 0.002), ESR (P < 0.0001), CRP (P < 0.0001), D-dimer levels (P = 0.006) and the presence of VUR (P < 0.0001) were significantly higher in the APN group than in the lower UTI group. Multiple logistic regression analyses showed that D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001-1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499-0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN. Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.

Detection of PCT and urinary β2-MG enhances the accuracy for localization diagnosing pediatric urinary tract infection

ObjectiveThe purpose of this article was to investigate whether the combination of urinary beta 2 microglobulin (urinary β2‐MG) and procalcitonin (PCT) diagnosis could enhance the localization diagnostic precision of pediatric urinary tract infection comparing with single diagnosis.MethodsA study was conducted in the Nephrology Department of Wuhan women and children's health care centre. This study incorporated 85 participants, including 35 children who were diagnosed as upper urinary tract infection (UUTI) with the symptom of fever and 50 children who conducted lower urinary tract infection (LUTI). Levels of PCT and urinary β2‐MG in both UUTI and LUTI patients were measured and compared.ResultsThe level of PCT and β2‐MG were both significantly higher in UUTI group compared with in LUTI group. AUC of urinary β2‐MG ROC (sensitivity of 71.4%, specificity of 90.0%) was significantly smaller than that of PCT ROC (sensitivity of 77.1%, specificity of 96.0%) in the single diagnosis. Although in the combined diagnosis, the sensitivity and specificity increased to 88.6% and 98%, respectively.ConclusionsBoth PCT and β2‐MG could be used to localize the UTI. Introducing urinary β2‐MG into PCT diagnosis could increase the sensitivity and specificity of UTI lesion diagnosis in clinical practice.

Mean platelet volume in young children with urinary tract infection

Mean platelet volume (MPV) has not yet been well-established in urinary tract infection (UTI). The purpose of this study was to evaluate the role of MPV as an acute phase reactant in children with UTI. Data from 118 young children (<2 years) with UTI between 2012 and 2013 were grouped as acute pyelonephritis (APN) and lower UTI according to the dimercaptosuccinic acid (DMSA) scan abnormalities. MPV, platelet distribution width (PDW) platelet count, and other infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) were measured. WBC (P = 0.001), ESR (P = 0.005), CRP (P < 0.001) and MPV levels (P = 0.011) were significantly higher in the APN group than those in the lower UTI group. MPV positively correlated with PDW, CRP and negatively with platelet count. Multiple logistic regression analyses showed that CRP and MPV were independent predictive factors for APN patients. However, the area under the Receiver Operating Characteristic (ROC) curve analysis for MPV was lower than CRP. Our results suggest that MPV can be an inflammatory marker in UTI, but the predictive value of MPV was not superior to CRP in the diagnosis of APN.

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections.

The identification of acute pyelonephritis (APN) is still a challenge. Patients admitted for their first urinary tract infection (UTI) were enrolled. Plasma neutrophil gelatinase-associated lipocalin (NGAL) levels were measured at admittance and after treatment. Laboratory, clinical, and imaging results were compared between children with and without APN. A total of 123 patients were enrolled (53 APN and 70 lower UTI). After adjusting for age and gender, plasma NGAL levels were higher in the APN group than in the lower UTI group (233 (129-496) ng/ml vs. 71 (50.8-110) ng/ml, P < 0.001). NGAL levels were correlated with the serum levels of leukocytes, C-reactive protein, and creatinine, as well as fever duration (P < 0.05). Multivariable analysis revealed that log-transformed plasma NGAL was an independent predictor of APN (P < 0.05). Receiver operating curve analysis showed a good diagnostic profile of NGAL for identifying APN (area under the curve 0.864) with a best cut-off value of 102.5 ng/ml. The NGAL levels in both two groups decreased after treatment compared to levels before treatment (P < 0.001). Plasma NGAL can be a sensitive predictor for identifying APN and monitoring the treatment response of pediatric UTI.

Optical diagnosis of lower urinary tract infection: A pilot study in children

Conventionally, diagnosis of lower urinary tract infection (LUTI) is made on the basis of history, urine microscopy and culture. But there are limitations to this methodology especially in children and special populations where there is difficulty in obtaining a full history and details of clinical symptoms. The aim of this study was to determine if monitoring bladder wall oxygenation as a measure of bladder mucosal inflammation using transcutaneous near-infrared spectroscopy (NIRS) allows detection of the presence or absence of LUTI in children. A convenience sample of children referred to a pediatric urology clinic with an acute LUTI and a control group were studied. Diagnosis was confirmed by history, physical examination, laboratory investigations, and urine culture. Participants had transcutaneous measurement of an absolute measure of tissue oxygen saturation (TSI%) in their bladder wall, and a quadriceps muscle control site, using a spatially resolved (SR) wireless NIRS device. Average measures of bladder wall TSI% (B.TSI%) and quadriceps TSI% (Q.TSI%) and their differences (TSI.diff) were calculated and compared between those with LUTI and controls by performing a two-way repeated analysis of variance. Thirty-four patients met the inclusion criteria (LUTI n = 12 and controls n = 22). Comparing LUTI to controls B.TSI% and TSI.diff values were significantly higher in the LUTI group (p < 0.0001), while Q.TSI% values were not significantly different. Optical monitoring of bladder wall oxygenation is feasible in children. In this study a significant difference was evident in a SR NIRS-derived measure of absolute oxygen saturation in the bladder wall between children with UTI diagnosed by conventional testing methods, and those in a control group without infection. SR-NIRS monitoring of bladder wall oxygenation may offer a rapid and non-invasive means of bedside screening for LUTI where history and/or clinical signs are not available or adequate.

Is the mean platelet volume a predictive marker for the diagnosis of acute pyelonephritis in children?

Acute pyelonephritis (APN) can lead to renal scar formation, high blood pressure, and end-stage renal failure. Prompt and early diagnosis of APN is important for preventing future complications. Our goal was to study the mean platelet volume (MPV) as a predictor of APN in children. The records of 43 patients with APN and 51 patients with a lower urinary tract infection (UTI) were investigated prospectively. APN was confirmed using radioactive nuclide 99mTc-DMSA scanning. The white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), and MPV of both groups were measured and compared. The WBC count, MPV and ESR values, and the serum concentration of CRP were higher in the APN group than in the lower UTI group (p < 0.05). In the children with APN, the optimal cut-off value for the MPV was 8.2 fl [area under the curve (AUC): 0.906], with sensitivity of 81.4 % and specificity of 86.3 %. The MPV was associated with APN (p = 0.001), and the sensitivity and specificity of the MPV for the diagnosis of APN were higher than those of the other inflammation markers. MPV > 8.2 fl yielded an adjusted OR of 7.8 (95 % CI 3.3-18.4, p < 0.001) for APN. MPV > 8.2 fl was significantly associated with late renal scar formation (adjusted OR 5.7, 95 % CI 2.3-13.8, p < 0.001). The MPV is a fast and reliable measurement with considerable predictive value for the diagnosis of APN and renal scars, and its predictive capacity is better than that of CRP, ESR, and WBC values.

MP8-03 OPTICAL DIAGNOSIS OF LOWER URINARY TRACT INFECTION: A PILOT STUDY IN CHILDREN.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2014MP8-03 OPTICAL DIAGNOSIS OF LOWER URINARY TRACT INFECTION: A PILOT STUDY IN CHILDREN. Babak Shadgan, A.M. Kajbafzadeh, Lynn Stothers, Macnab Andrew, and Mark Nigro Babak ShadganBabak Shadgan More articles by this author , A.M. KajbafzadehA.M. Kajbafzadeh More articles by this author , Lynn StothersLynn Stothers More articles by this author , Macnab AndrewMacnab Andrew More articles by this author , and Mark NigroMark Nigro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract infection (LUTI) is a common and important urological condition that requires early diagnosis and treatment. Diagnosis is based on history and clinical symptoms confirmed by positive urine culture, which although feasible for the general population, it is not readily applicable in young children and individuals with neurogenic bladder where a reliable history and changes in sensation are lacking. As UTI-induced bladder inflammation is associated with an increase in perfusion and oxygen consumption, an optical method akin to oximetry capable of detecting changes in bladder oxygenation could provide early detection of LUTI. OBJECTIVE To determine if monitoring bladder oxygenation as a measure of bladder mucosal inflammation using transcutaneous near-infrared spectroscopy (NIRS) allows detection of the presence or absence of LUTI in children. METHODS A convenience sample of children referred to a pediatric urology clinic with an acute LUTI, and a control group, were studied. Diagnosis was confirmed by history, physical examination, laboratory investigations and culture. Participants had transcutaneous measurement of an absolute measure of tissue oxygen saturation (TSI%) in their bladder wall, and a quadriceps muscle control site, using a wireless NIRS device. RESULTS Thirty-four patients met the inclusion criteria (LUTI n=12 and controls n=22). Comparing LUTI to controls B.TSI% and TSI.diff values were significantly higher in the LUTI group (p<0.0001), while Q.TSI% values were not significantly different. CONCLUSIONS NIRS optical monitoring of an absolute measure of bladder wall oxygenation (TSI%) may offer a means of screening for LUTI where history and/or clinical signs are not available or adequate. Non UTI Group UTI Group Significance Q.TSI% Mean 67.9 70.4 P=0.20 SD (+ -) 6.5 5.4 Range 56.2-78.9 60.7-75.6 B.TSI% Mean 66.8 80.8 p=< 0.0001 SD (+ -) 7.3 5.9 Range 49.1-77.1 70.5-89.9 TSI diff Mean -1.1 10.4 P< 0.0001 SD (+ -) 3 3.9 Range -5.8-2.6 5.2-16.7 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e75 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Babak Shadgan More articles by this author A.M. Kajbafzadeh More articles by this author Lynn Stothers More articles by this author Macnab Andrew More articles by this author Mark Nigro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Significance of joint detection of serum cystatin C, procalcitonin, and urine N-acetyl-β-D-glucosaminidase combined detection on localization diagnosis of the urinary tract infection in children

Objective To explore the differences of biological markers level between upper urinary tract infection(UUTI) and lower urinary tract infection(LUTI) in children for providing help for localization diagnosis of urinary tract infection(UTI). Methods One hundred and nine children with UTI hospitalized in Children's Hospital of Tianjin from May 2010 to Jan.2012 were divided into UUTI group (18 cases) and LUTI group (91 cases). The clinical information (sex, age, onset symptoms), laboratory test including blood urea nitrogen and creatinine, biological markers including serum cystatin C(CysC), procalcitonin(PCT), β2-microglobulin (β2-MG), urine microalbumin(mAlb), transferrin(TF), α1-microglobulin(α1-MG), β2-MG and N-acetyl-β-D-glucosaminidase(NAG)were recorded. Then SPSS 17.0 software was used to analyze the data. Results UUTI children showed higher level of serum CysC, PCT, urine mAlb, TF, α1-MG, β2-MG and NAG than LUTI children did.The area under ROC curve of the 7 biological markers were all between 0.71 and 0.87.Logistic regression test was used to do multiple regression analysis and establish the multiple regression model.The standard of eliminating or screening variables was 0.05.CysC, PCT, NAG were identified as influence factors.Combining test result of CysC, PCT, NAG could improve diagnostic value so that the sensitivity could reach 90%and the specificity could reach 88.9%. Conclusions Both of serum CysC, PCT and urine mAlb, TF, α1-MG, β2-MG, NAG can be used for the positioning diagnosis of UTI, and the diagnostic value of joint test of serum change of CysC, PCT, urine NAG is higher than any single biological marker. Key words: Urinary tract infection; Cystatin C; Procalcitonin; N-acetyl-β-D-glucosaminidase; Early renal damage; Localization diagnosis

Serum levels of interleukin-6 and interleukin-8 as diagnostic markers of acute pyelonephritis in children

PurposeEarly diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis.MethodsEighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared.ResultsThere was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP.ConclusionThis study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.

Serum and urine levels of interleukin-6 and interleukin-8 in children with acute pyelonephritis

Urinary tract infection (UTI) is a common clinical disorder in younger infants and children and may result in permanent renal damage. The inflammatory cytokines interleukin (IL)-6 and IL-8 play an important role in response to bacterial infection. This prospective study investigated the association between serum and urine IL-6 and IL-8 levels and acute pyelonephritis confirmed by 99mTc-dimercaptosuccinic acid (DMSA) scan. A total of 78 children aged 1–121 months with a diagnosis of first-time febrile UTI were included. The following inflammatory markers were assessed: fever; white blood cells count (WBC); C-reactive protein (CRP); and serum and urine IL-6 and IL-8. The patients were divided into the acute pyelonephritis group ( n = 42) and the lower UTI group ( n = 36) according to the results of DMSA scan. Fever, WBC and CRP levels were significantly higher in children with acute pyelonephritis than in those with lower UTI (all p < 0.001). Significantly, higher initial serum and urine IL-6 and IL-8 levels were found in children with acute pyelonephritis than in those with lower UTI (all p < 0.001). Serum and urine IL-6 in children with acute pyelonephritis were positively correlated with fever, CRP and leucocyturia. These results indicate that both serum and urine IL-6 and IL-8 levels, particularly IL-6, are useful diagnostic tools for early recognition of acute pyelonephritis in febrile children.

Procalcitonin as a marker of acute pyelonephritis in infants and children.

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin (PCT) levels and compared these with other commonly used inflammatory markers. We evaluated the ability of serum PCT levels to predict renal involvement, as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. Serum C-reactive protein (CRP), leukocyte counts, and PCT levels were measured in 64 children admitted for suspected UTI. Renal parenchymal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. In acute pyelonephritis, the median PCT level was significantly higher than in the lower UTI group (3.41, range 0.36-12.4 microg/l vs. 0.13, range 0.02-2.15 microg/l, P<0.0001). In these two groups, respectively, median CRP levels were 120 (range 62-249 mg/l) and 74.5 (range 14.5-235 mg/l, P=0.012) and leukocyte counts were 15,910/mm(3) (range 10,200-26,900) and 14,600/mm(3) (range 8,190-26,470, P=0.34). For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT were 94.1% and 89.7%, respectively; CRP had a sensitivity of 100%, but a specificity of 18.5%. We conclude that serum PCT may be an accurate marker for early diagnosis of acute pyelonephritis.