PURPOSE: It is difficult to make a distinction between lower urinary tract infection(UTI) and acute pyelonephritis(APN) during the acute phase of febrile UTI due to nonspecific clinical symptoms and laboratory findings, especially among young children. We measured the serum procalcitonin(PCT) in children with UTI to distinguish between acute pyelonephritis and lower UTI, and to determine the accuracy of PCT measurement compared with other inflammatory markers. METHODS: Serum samples were taken from children who admitted with unexplained fever or were suspected of having UTI. 51 children(mean 12.2+/-11.4 months) were enrolled in this study. Leukocyte counts, erythrocyte sedimentation rates(ESR) and C-reactive protein(CRP) were also measured. Renal parenchymal involvement was assessed by (99m)Tc DMSA scintigraphy in the first 7 days after admission. PCT was measured by immunoluminometric assay. RESULTS: PCT values were significantly correlated with the presence of renal defects in children with UTI(n=16)(5.06+/-12.97 microgram/L, P<0.05). However, PCT values were not significantly different between children with UTI without renal damage(n=18) and children without UTI(n=17). Using a cutoff of 0.5 microgram/L for PCT and 20 mm/hr for ESR, 20 mg/L for CRP, sensitivity and specificity in distinguishing between UTI with and without renal involvement were 81.3 percent and 88.9 percent for PCT 87.5 percent and 72.2 percent for ESR, and 87.5 percent and 55.6 percent for CRP, respectively. Positive and negative predictive values were 86.7 percent and 84.2 percent for PCT and 60.9 percent and 81.8 percent for CRP, respectively. CONCLUSION: In febrile UTI, PCT values were more specific than CRP, ESR and leukocyte count for the identification of patients who might develop renal defects.
Blood Sedimentation ; Child* ; Diagnosis* ; Fever ; Humans ; Leukocyte Count ; Pyelonephritis ; Radionuclide Imaging ; Sensitivity and Specificity ; Succimer ; Urinary Tract Infections* ; Urinary Tract*

We carried out a prospective study with three aims:(1) to observe the renal computed tomography (CT) patterns in APN; (2) to compare the radiological imaging techniques used for the diagnosis of APN(renal CT and DMSA scintigraphy); (3) to correlate the clinical manifestations with CT findings in APN. Between 1 April 1997 and 31 March 1998, all adults who were admitted to our internal medicine ward with APN were included in this study. They presented with symptoms and signs of upper UTI, accompanied by pyuria and bacteriuria. All patients with renal abscess, or uropathy on the ultrasound (US) examination, were excluded from the study. 23 cases of APN were evaluated. There were 22 females and 1 male. The mean age of 23 cases was 45+/-19 years old(from 20 to 79 years old). Two cases we re diabetics. On the basis of postcontrast- enhanced CT findings, 23 cases were grouped into (1) Group I(6 cases), no abnormal lesions; (2) Group II(13 cases), wedge-shaped lesions (focal or diffuse); (3) Group III(2 cases), focal mass-like lesions; and (4) Group IV(2 cases), diffuse mass-like lesions. The incidences of CT and DMSA scintigraphy abnormalities were 74%(17/23) and 68%(13/19), respectively. A significant correlation was demonstrated between the clinical parameters(including duration of flank pain and fever, ESR, serum creatinine, and degree of pyuria) and the pattern of renal parenchymal findings detected on CT(P<0.05). In conclusion, we classify APN into four subgroups according to CT findings, and suggest that renal CT is useful in the diagnosis and assessment of severity of APN.
Abscess ; Adult ; Bacteriuria ; Creatinine ; Diagnosis ; Female ; Fever ; Flank Pain ; Humans ; Incidence ; Internal Medicine ; Male ; Prospective Studies ; Pyelonephritis* ; Pyuria ; Radionuclide Imaging ; Succimer ; Ultrasonography

PURPOSE: The aim of this study is to investigate the association between elevated alanine aminotransferase (ALT) and urosepsis in children with acute pyelonephritis (APN). METHODS: We retrospectively identified all children who were managed in our hospital with APN during a decade period. In our study a diagnosis of APN was defined as having a positive urine culture and a positive (99m)Tc-dimercaptosuccinic acid scintigraphy. We compared those with elevated ALT and those with normal ALT according to the following variables: age, gender, duration of fever prior to admission, presence of hypotension, C-reactive protein (CRP), creatinine, presence of anemia, white blood cells count, platelet count, blood culture result, and grades of vesicoureteral reflux. In addition, the correlation between elevated ALT and positive blood culture was analyzed in detail. RESULTS: A total of 996 children were diagnosed with APN, of which 883 were included in the study. ALT was elevated in 81 children (9.2%). In the analysis of demographic characteristics, the number of children with elevated ALT was higher in children between 0 to 3 months, boys, and in those with positive blood culture (p=0.002, 0.036, and 0.010, respectively). In multivariate analysis of variables associated with positive blood culture, age younger than 3 months, elevated ALT, elevated CRP, and elevated creatinine showed statistical significance (p=0.004, 0.030, 0.043, and 0.044, respectively). CONCLUSION: Our study demonstrates the association between elevated ALT and increased prevalence of urosepsis in addition to elevated CRP, elevated creatinine, and age younger than 3 months in children with APN.
Alanine Transaminase* ; Alanine* ; Anemia ; C-Reactive Protein ; Child* ; Creatinine ; Diagnosis ; Fever ; Humans ; Hypotension ; Infant ; Leukocytes ; Multivariate Analysis ; Platelet Count ; Prevalence ; Pyelonephritis* ; Radionuclide Imaging ; Retrospective Studies ; Vesico-Ureteral Reflux

PURPOSE: We investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI). MATERIALS AND METHODS: We examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed. RESULTS: CRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN. CONCLUSION: We conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.
Acute Disease ; C-Reactive Protein/*analysis ; Case-Control Studies ; Fever/microbiology ; Humans ; Infant ; Male ; Potassium/*urine ; Predictive Value of Tests ; Prospective Studies ; Proteinuria/diagnosis ; Pyelonephritis/*diagnosis/radionuclide imaging ; Sensitivity and Specificity ; Sodium/*urine ; *Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections/drug therapy/microbiology/*radionuclide imaging