Urinary concentration of cytokines in children with acute pyelonephritis

Urinary tract infection (UTI) is a common bacterial infection among infants and children. Predicting which children with upper UTI will develop long-term sequelae remains difficult. We aimed at evaluating the predictive value of urine concentrations of interleukin-6 (UIL-6) and interleukin-8 (UIL-8) in subsequent renal scarring. In the current observational prospective study, urine samples for UIL-6 and UIL-8 were obtained from two groups: 31 children with first episode of febrile UTI and 22 febrile children of other origin. UIL-6 and UIL-8 were increased in children with febrile UTI, compared to children with fever of other origin [median and range (picograms per milliliter): (1) UIL-6, 74.46 (0–168) vs. 10.51 (0–47.50), respectively, p?=?0.0001; (2) UIL-8, 2,660.38 (0–13,801) vs. 0, respectively, p?=?0.0001]. Renal scarring was found in 5/31 (16 %) children with acute pyelonephritis. Initial median UIL-8 values were significantly higher in children with later renal scarring than in those without renal scarring [median and range (picograms per milliliter): 6,163 (2,021–13,801) vs. 1,490.5 (0–5,737), respectively, p?=?0.018]. In conclusion, UIL-8 might serve as a predictive biomarker for renal scarring after an acute episode of pyelonephritis. Since UIL-8 emerges as a renal-specific diagnostic and prognostic marker, it may be suitable as a selective screening tool for children with febrile UTI.     

Iron Stores in Low and Normal Birth Weight Infants at Birth and in Early Infancy

Serum ferritin levels of low birth weight (LBW; BW?<?2,500 g) and normal birth weight (NBW; BW?≥?2,500 g) infants were evaluated at birth and at 3 mo using electrochemiluminescence immunoassay. At birth, levels were 318.6 (31.0–829.5) ng/mL in LBW (n?=?217) and 366.2 (122.4–858.5) ng/mL in NBW infants (n?=?116; p?<?0.01), with 1.4 % of LBW and none of the NBW infants having levels <12 ng/mL (p?=?0.20). At follow up, levels were 66.9 (4.5–567.7) ng/mL in LBW (n?=?126) and 126.2 (6.8–553.7) ng/mL in NBW infants (n?=?76; p?=?0.27), with 11.9 % of LBW and 11.8 % of NBW infants having levels <12 ng/mL (p?=?0.80).     

Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates

Objective

To determine the clinical utility of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy (HIE).

Design

Cohort study.

Settings

National Intensive Care Unit of Maternity Hospital, Ain Shams University, Cairo, Egypt.

Patients

The study included 30 term asphyxiated neonates (8 with mild, 13 with moderate and 9 with severe HIE) and 20 control neonates.

Intervention

Serum NGAL level was measured within 6 hours after birth using an enzyme linked immunosorbent assay.

Main outcome measures

Patients were subsequently discriminated into AKI (n=12) and no-AKI (n=18) groups.

Results

The median (Interquartile range) serum NGAL concentration was 95.0 (70.75–180.00) ng/mL in asphyxiated neonates, and 39.75 (6.0–48.0) ng/mL in control neonates; (P<0.001). Serum NGAL correlated with HIE severity: mean (SD) was 65.50 (3.77) ng/mL in infants with mild HIE, 115.07 (45.83) ng/mL in infants with moderate HIE and 229.66 (79.50) ng/mL in infants with severe HIE; (P<0.01). The median (Interquartiles) serum NGAL level was 182.50 (166.25–301.75) ng/mL in patients with AKI, 74.00 (66.00–78.75) ng/mL in those without AKI; (P<0.001). A cutoff value 157 ng/mL for serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 83.3% and a specificity of 94.4%.

Conclusion

Elevated serum NGAL measured within 6 hours after birth reliably indicates acute kidney injury in asphyxiated neonates.     

降钙素原对儿童急性肾盂肾炎的诊断价值

目的：探讨降钙素原（PCT）对儿童急性肾盂肾炎（APN）的诊断价值。方法：回顾性分析2011年9月至2012年2月诊断为初发的尿路感染（UTI）且年龄<3岁患儿的病例资料,以核素肾静态扫描（99mTc-DMSA）结果作为诊断APN的金标准,比较上尿路感染（APN）及下尿路感染（非APN）患儿血清PCT、CRP的水平,并绘制二者诊断APN的受试者工作特征曲线（ROC曲线）,判断其诊断性能。结果：共65例UTI患儿纳入研究,其中APN 39例,下尿路感染者26例,前者的血清PCT、CRP水平显著高于后者（分别 3.08 ng/mL vs 0.37 ng/mL;6.25 mg/L vs 3.01 mg/L;均P<0.01）。血清PCT诊断APN的敏感性为84.6%,特异性为88.5%,曲线下面积为0.873（95%可信区间为0.781~0.965）,最佳阈值为1.03 ng/mL;血清CRP诊断APN的敏感性为71.8%,特异性为69.2%,曲线下面积为0.735（95%可信区间为0.612~0.858）,最佳阈值为3.91 mg/L。结论：PCT对儿童APN的诊断具有较高的敏感性及特异性,有助于临床对APN的早期识别。     

Low serum 25-hydroxyvitamin D levels and bronchiolitis severity in Spanish infants

This cross-sectional study was performed to examine the prevalence of hypovitaminosis D in infants with acute bronchiolitis compared with control subjects and to evaluate the relationship between serum 25-hydroxyvitamin D (25(OH) D) and the severity of bronchiolitis. Serum 25(OH) D levels were measured by radioimmunoassay in 48 infants with acute bronchiolitis (2.5?±?2.0 months) and in 30 healthy infants (3.2?±?2.3 months). 25(OH) D levels (ng/ml) in children with acute bronchiolitis were significantly lower than in the control group (median 29.9 ng/ml (interquartile range (IQR) 21.4–37.5) versus median 38.2 ng/ml ((IQR 26.1–48.1), p?=?0.022), mainly in infants with moderate–severe bronchiolitis (median 29.8 ng/ml, IQR 19.2–35.9). The prevalence of hypovitaminosis D was remarkably greater among infants with bronchiolitis than in control subjects (52.1 versus 26.6 %). A significant inverse correlation was found between serum 25-hydroxyvitamin D levels and disease severity (rho?=??0.457, p?<?0.001). Conclusion: The prevalence of hypovitaminosis D is high in Spanish infants with bronchiolitis. The severity of acute bronchiolitis increases with a decline in serum 25 (OH) D level.     

Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis

This prospective study was done to assess the frequency of acute pyelonephritis (APN) in febrile children with positive urine culture as documented by Tc99m DMSA scintigraphy (DMSA) and the frequency of vesicoureteric reflux (VUR) in these children. Secondly, to determine the frequency of APN, in febrile children with supportive evidence for UTI but with negative urine culture, as documented by DMSA and frequency of VUR in them. Thirdly to stress the utility of DMSA to diagnose APN in urine culture negative febrile children and to suggest DMSA as a clinical tool in evaluation of fever of unknown origin (FUO). This study included 42 children with positive urine culture and 26 children with negative urine culture who had supportive evidence of UTI as determined by the predetermined criteria and diagnosed to have APN by DMSA. All of them had ultrasonogram (USG), DMSA and voiding cystourethrogram (VCU). They were followed up for a minimum period of 6 months. Out of the 42 children with positive urine culture 92.9% had features of APN in the DMSA of whom 82.1% had vesicoureteric relux (VUR). The DMSA was abnormal in 26 children with negative urine culture, of whom 65.4% had VUR. Ultrasound suggestive of parenchymal change was observed in 47.6% in the culture positive group and 65.4% in the culture negative group. In conclusion, it is suggested, that DMSA is a useful investigation for the diagnosis of APN in febrile UTI. DMSA is indicated in febrile children with negative urine culture but with supportive evidence of UTI and in FUO. An abnormal DMSA is a strong indication for work up for VUR.     

Impact analysis of an evidence-based guideline on diagnosis of urinary tract infection in infants and young children with unexplained fever

Several guidelines exist on urinary tract infection (UTI) in children. The objectives of this study were to (1) implement an evidence-based diagnostic guideline on UTI and evaluate determinants of successful implementation, and (2) determine compliance to and impact of the guideline in febrile, non-toilet trained children at the emergency department (ED). We performed a prospective cross-sectional observational study, with observations before and after implementation. Children aged 1 month to 2 years, presenting at the ED with unexplained fever (temperature above 38.5 °C), were included. We excluded children with a chronic underlying disease. Primary outcome measure was compliance to the standardized diagnostic strategy and determinants influencing compliance. Secondary outcome parameters included the following: number of used dipsticks, contaminated cultures, number of genuine UTI, frequency of prescribed antibiotic treatment, and hospitalization. The pre-intervention group {169 children (male 60.4 %, median age 1.0 [range 0.1–2.0])} was compared with the post-intervention group {150 children (male 54.7 %, median age 1.0 [range 0.1–1.9])}. In 42 patients (24.9 %), there was compliance to local guidelines before implementation, compared with 70 (46.7 %) after implementation (p-value?<?0.001). Improvement in compliance after implementation was higher in patients 3–24 months and outside the office hours (p?<?0.001). Conclusion: Implementation of a guideline for diagnosing UTI in febrile children at the ED has led to a significantly better compliance, especially in children aged 3–24 months. However, this study also underlines the need for a well-defined implementation strategy after launching an (inter)national guideline, taking determinants influencing implementation into account.     

Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?

ObjectiveTo compare the incidence and type of urinary tract infection (UTI) in patients with primary vesicoureteral reflux (VUR) diagnosed after a febrile UTI while they were on prophylactic antibiotics (PA) and after stopping PA.Materials and methodsCriteria to discontinue PA were: no UTI during 12+ or more months on PA, old enough to communicate UTI symptoms, potty trained and absence of risk factors for UTI. Patients with at least 1 year of follow up without PA were included (n = 77). We recorded: age at which PA was indicated and stopped, time on and off PA, incidence and type of UTI (cystitis vs acute pyelonephritis (APN)), and renal scan results.ResultsPA was started and stopped at a mean age of 18.5 and 61 months, respectively. Mean time on PA was 39 months (range 12–95): 25 patients had 44 UTI episodes (0.17 episodes/patient/year), and 31 (70%) of them were APN. Mean time of antibiotics was 44.5 months (range 12–162): 13 patients had 24 UTI episodes (0.08 episodes/patient/year), eight (33%) of which were APN (P < 0.05). A renal scan was performed in 71 patients after the index infection and repeated in 12. Two patients lost renal function while still on PA.ConclusionDiscontinuing PA in patients with history of VUR is a safe practice and should be considered as a management option.     

Lack of value of midregional pro-adrenomedullin and C-terminal pro-endothelin-1 for prediction of severe bacterial infections in infants with fever without a source

The study was performed to assess the usefulness of two new biomarkers, midregional pro-adrenomedullin (MR-pro-ADM) and C-pro-endothelin-1 (CT-pro-ET-1), in predicting bacterial infection (BI) and especially invasive bacterial infection (IBI) in well-appearing infants with fever without source (FWS). For this purpose, a multicenter prospective study was conducted between February 2008 and March 2009 including well-appearing infants less than 36 months of age with FWS. MR-pro-ADM, CT-pro-ET-1, procalcitonin (PCT), CRP, and WBC were measured and compared. Among the 1,035 infants included, a bacterial infection was diagnosed in 75 patients (7.2 %), and 16 (1.54 %) had an invasive bacterial infection (bacterial meningitis, 8; occult bacteremia, 6; and sepsis, 1). MR-pro-ADM and CT-pro-ET-1 levels were less reliable for diagnosis than the other biomarkers. The area under receiver operating characteristic curve for infants with BI and IBI was 0.59 (95 % confidence interval (CI) 0.52–0.67) and 0.63 (95 % CI 0.46–0.80) for MR-pro-ADM and 0.58 (95 % CI 0.51–0.66) and 0.62 (95 % CI 0.47–0.67) for CT-pro-ET-1, respectively. Multivariate analysis showed that PCT ≥ 0.5 ng/mL, CRP ≥ 40 mg/L, and CT-pro-ET-1 ≥ 105 pmol/mL were independent risk factors for having a BI (odds ratio (OR) 6.12, 3.61, and 2.84, respectively). PCT was the only independent risk factor for having an IBI (OR 17.53 if PCT ≥ 0.5 ng/mL). Conclusion: Although baseline MR-pro-ADM and CT-pro-ET-1 levels are significantly elevated in well-appearing febrile infants with a bacterial infection, their overall performance as diagnostic markers is very poor.     

Clinical efficacy of gabexate mesilate for acute pancreatitis in children

Children with acute pancreatitis have been treated by fasting and parenteral nutritional support, and to date, the efficacy of drugs for acute pancreatitis in children is unclear. Gabexate mesilate is a synthetic serine protease inhibitor used to prevent or treat acute pancreatitis in adult patients. The purpose of this study was to evaluate the clinical efficacy of gabexate for acute pancreatitis in children. Fifty-three children hospitalized with acute pancreatitis between 2004 and 2012 were divided between a gabexate-treated group (n?=?26) and a control group without gabexate infusion (n?=?27). The severity of acute pancreatitis was graded according to Balthazar scoring of computed tomography images. All subjects had a Balthazar score of <4 without pancreatic necrosis or organ failure. The median age of the patients was 11.8 years (range, 18 months–17 years). The durations of hospitalization, abdominal pain, and parenteral nutrition in the gabexate-treated group were significantly shorter than in control subjects (P?=?0.032, P?=?0.000, and P?=?0.016, respectively). Serum levels of amylase and lipase were significantly lower in gabexate-infused children than in control subjects on day 7 (median amylase, 81 vs. 137 IU/L, P?=?0.001; median lipase, 273 vs. 523 IU/L, P?=?0.031). Conclusion: The present study showed that gabexate infusion has some clinical benefits for acute pancreatitis in children. The clinical application of gabexate for managing acute pancreatitis in children may be appropriate beyond conventional therapy.     

Lung function of preterm infants before and after viral infections

Our aim was to determine whether viral lower respiratory tract infections (LRTIs) adversely affect prematurely born infants’ lung function at follow up. Seventy infants, median gestational age 34 (range, 24–35)?weeks were prospectively followed; 32 had an RSV (n?=?14) or another respiratory viral (n?=?18) LRTI (viral LRTI group) and 38 had no LRTI (no LRTI group). Six of the viral LRTI and five of the no LRTI group had been hospitalised. Nasopharyngeal aspirates (NPAs) obtained whenever the infants had an LRTI. Lung function (functional residual capacity [FRC_He], compliance [Crs] and resistance [Rrs] of the respiratory system) was measured at 36 weeks postmenstrual age (PMA) and 1 year corrected. At 1 year, lung volume (FRCpleth) and airways resistance (Raw) were also assessed. There were no significant differences in the lung function of the two groups at 36 weeks PMA but at 1 year, the viral LRTI compared to the no LRTI group had a higher mean Raw (23 versus 17 cm H₂O/l/s, p?=?0.0068), the differences remained significant after adjustment. Conclusion: These results suggest viral LRTIs, regardless of whether hospitalisation is required, adversely affect prematurely born infants’ airway resistance at follow up.     

Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants

Objective

To investigate the effect of Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants.

Methods

Fifty preterm infants born at 28–36 wk with a birth weight ranging from 1,000–2,000 g were recruited for the study. They were block randomized into a control group (n?=?25) and study group (n?=?25). New Ballard score was used for the baseline measurement of neuromaturity in both groups. In neonatal intensive care unit (NICU), the study group received multisensory stimulation for 12 min per session, 5 sessions per wk along with routine NICU care either from 33 wk corrected gestational age for infants born at 28–32 wk or from 48 h of birth for infants born at 33–36 wk until discharge from the hospital. The control group received the routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test.

Results

The multisensory stimulated infants showed higher neuromotor score (p?=?0.001) compared to the control group. The french angle components of INFANIB including heel to ear (p?=?0.016) and popliteal angle (p?=?0.001) were statistically significant between the groups.

Conclusions

Multisensory stimulation appears to have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted to investigate the long-term effects of multisensory stimulation on neurodevelopmental outcome in preterm infants.     

Effect of non-human neutral and acidic oligosaccharides on allergic and infectious diseases in preterm infants

Short-term supplementation of non-human neutral and acidic oligosaccharides during the first postnatal weeks may enhance the maturation of the immune response in preterm infants and may lead to less allergic and infectious diseases during the first year of life. In a randomized controlled trial, 113 preterm infants (gestational age <32 weeks and/or birth weight <1500 g) were allocated to receive enteral neutral and acidic oligosaccharide supplementation or placebo between days 3 and 30 of life. The median age at follow-up was not different in both groups: 12 months corrected age (interquartile range [IQR], 11–15) in the prebiotic mixture group and 12 months corrected age in the placebo group (IQR, 10–19), respectively. In addition, baseline patient, maternal, and environmental characteristics were not different between the prebiotic mixture (n?=?48) and placebo (n?=?46) group. Incidence of allergic and infectious diseases was assessed by validated questionnaires. In total, 94/98 (96 %) of the eligible, surviving infants participated in this follow-up study. The incidence of atopic dermatitis (odds ratio [OR], 0.80; 95 % confidence interval [CI], 0.24–2.67), bronchial hyper-reactivity (OR, 1.04; 95 % CI, 0.38–2.87) and infections of the upper respiratory (OR, 0.95; 95 % CI, 0.37–2.44), lower respiratory (OR, 1.03; 95 % CI, 0.37–2.88), and gastrointestinal (OR, 1.77; 95 % CI, 0.55–5.73) tract was not different between the groups. Adjustment for potential confounding factors did not change the results of the primary analysis. Conclusion: Short-term enteral supplementation of non-human neutral and acidic oligosaccharides during the neonatal period in preterm infants does not decrease the incidence of allergic and infectious diseases during the first year of life.     

Vitamin D status and predictors of hypovitaminosis D in Italian children and adolescents: a cross-sectional study

Hypovitaminosis D affects children and adolescents all around the world. Italian data on vitamin D status and risk factors for hypovitaminosis D during pediatric age are lacking. Six hundred fifty-two children and adolescents (range 2.0–21.0 years) living in the northwestern area of Tuscany were recruited at the Department of Pediatrics, University Hospital Pisa. None of them had received vitamin D supplementation in the previous 12 months. 25-hydroxyvitamin D (25-OH-D) and parathyroid hormone (PTH) levels were analyzed in all subjects. Severe vitamin D deficiency was defined as serum levels of 25-OH-D?<?25.0 nmol/L (10.0 ng/mL) and vitamin D deficiency as?<?50.0 nmol/L (20.0 ng/mL). Serum 25-OH-D levels of 50.0–74.9 nmol/L (20.0–29.9 ng/mL) indicated vitamin D insufficiency, whereas 25-OH-D levels?≥?75.0 nmol/L (30.0 ng/mL) were considered sufficient. Hypovitaminosis D was defined as 25-OH-D levels?<?75.0 nmol/L (30.0 ng/mL). The median serum 25-OH-D level was 51.8 nmol/L, range 6.7–174.7 (20.7 ng/mL, range 2.7–70.0), with a prevalence of vitamin D deficiency, insufficiency, and sufficiency of 45.9, 33.6, and 20.5 %, respectively. The prevalence of severe vitamin D deficiency was 9.5 %. Adolescents had lower median 25-OH-D levels (49.8 nmol/L, range 8.1–174.7; 20.0 ng/mL, range 3.2–70.0) than children (55.6 nmol/L, range 6.8–154.6; 22.3 ng/mL, range 2.7–61.9, p?=?0.006). Non-white individuals (n?=?37) had median serum 25-OH-D levels in the range of deficiency (28.2 nmol/L, range 8.1–86.2; 11.3 ng/mL, range 3.2–34.5), with 36/37 having hypovitaminosis D. Logistic regression showed significant increased risk of hypovitaminosis D in the following: blood samples taken in winter (odds ratio (OR) 27.20), spring (OR 26.44), and fall (OR 8.27) compared to summer; overweight (OR 5.02) and obese (OR 5.36) subjects compared to individuals with normal BMI; low sun exposure (OR 8.64) compared to good exposure, and regular use of sunscreens (OR 7.06) compared to non-regular use. Gender and place of residence were not associated with vitamin D status. The 25-OH-D levels were inversely related to the PTH levels (r?=??0.395, p?<?0.0001). Sixty-three out of the 652 (9.7 %) subjects showed secondary hyperparathyroidism. Conclusion Italian children and adolescents who were not receiving vitamin D supplementation had high prevalence of hypovitaminosis D. Careful identification of factors affecting vitamin D status is advisable to promptly start vitamin D supplementation in children and adolescents.     

99mTc-DMSA scintigraphy in acute urinary tract infection in children

24 children with symptomatic urinary tract infection (UTI) underwent systematically ultrasound studies (US) and^99mTc-DMSA renal scans. Among the 15 patients considered as acute pyelonephritis (APN) on clinical grounds, the scan was abnormal in 12 cases, in contrast with only 1 abnormal scan in the clincial subgroup of the lower UTI. Among the 10 abnormal scans that were repeated later on, 6 did completely normalize. US showed only once a parenchymal appearance suggestive for APN. Our findings suggest that the DMSA scan has to be considered at present as the most sensitive imaging technique for the detection of APN.     

Reference values of perfusion indices in hemodynamically stable newborns during the early neonatal period

We aimed to determine reference values of perfusion index (PI) in healthy newborns during the early neonatal period. Preductal (right hand) and postductal (foot) PI values were assessed during the first 5 days of life by using a new generation pulse oximetry. A total of 241 newborn infants (196 [81.3 %] term and 45 [18.7 %] preterm) were enrolled to the study. On the first day, in term infants, the median (interquartile range [IQR]) preductal and postductal PI were 1.35 (1.02–1.91) and 0.88 (0.62–1.22), respectively (p?=?0.001). These values were 0.88 (0.60–1.26) and 0.61 (0.35–0.92) in preterm infants, with the same respect (p?=?0.001). From the first to third days, preductal PI remained significantly higher than the postductal PI (p?<?0.001, for all comparisons). Both preductal and postductal PI of term newborns were significantly higher than those of preterm infants (p?<?0.001, for both comparisons). These differences in PI disappeared on the fifth day of life. Conclusion PI values which reflect peripheral perfusion seem to reach to a steady state on the fifth day of life following physiological maturation.     

Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection

Background  

99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).     

Comparison of Urinary Biomarkers for Early Detection of Acute Kidney Injury After Cardiopulmonary Bypass Surgery in Infants and Young Children

Acute kidney injury (AKI) is a potential complication for children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery. This study was designed to investigate and compare the predictive values of urinary biomarkers for AKI after CPB surgery in infants and young children and to determine the optimal timing of testing and the cutoff value for each biomarker. The study prospectively enrolled 58 CHD children 3 years of age or younger who were undergoing CPB surgery. Urinary neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), microalbumin (MA), N-acetyl-ß-D-glucosaminidase (NAG), α1-microglobulin (α1-MG), and creatinine (UCr) were measured at baseline and at various time points after surgery. Children who experienced AKI had more complex cardiac surgical procedures as evaluated by Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1), longer CPB and aortic clamping times, and worse clinical outcomes than those who did not. In the AKI group, all five urinary biomarkers increased substantially and peaked at 4 h after surgery. In contrast, in the non-AKI group, they increased slightly or had no significant changes during the first 24 h. All the biomarkers had the best predictive performances at 4 h after surgery. At this time point, NAG had the minimum area under the curve (AUC) (0.747), which was significantly lower than that of the others (AUC, 0.82–0.85; P < 0.05). The optimal cutoff value of each biomarker was 290 ng/mg UCr for NAGL, 1,477 pg/mg UCr for IL-18, 400 mg/g UCr for MA, 225 U/g UCr for NAG, and 290 mg/g UCr for α1-MG. In conclusion, urinary NGAL, IL-18, MA, and α1-MG had similar predictive performances for the early detection of AKI after CPB surgery in infants and young children.     

Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department

Background: Urinary tract infection (UTI) is a common problem in children. The aim of this study was to determine the usefulness of the procalcitonin (PCT) rapid test in the diagnosis of renal involvement in children with urinary tract infection. Methods: Through a case series study, PCT and C‐reactive protein rapid tests were measured in children with proven UTI at the Tehran Children's Medical Center, Iran. One‐hundred patients aged 1 month–14 years old (19 boys and 81 girls) with documented UTI were enrolled in the study. Results: Of 100 children, 62 patients (62%) had renal involvement on the basis of abnormal Tc‐dimercaptosuccinic acid scintigraphy and 38 patients (38%) had infection restricted to the lower urinary tract. There were no differences related to age or gender among the groups. The sensitivity and specificity of PCT were 77% and 89%, respectively, in prediction of renal involvement, whereas C‐reactive protein had a sensitivity of 80% and a specificity of 65%. Conclusion: We concluded that a rapid determination of PCT concentration could be useful for the management of children with febrile UTI in the emergency room.     

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR). 230 children, 90 girls and 140 boys with first febrile UTI were included. Radiologic (USG, DMSA, and VCUG), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (CBC with differential count, ANC (absolute neutrophil count), BUN, Creatinine, urine analysis, gram stain, culture, CRP and ESR) variables were analysed. DMSA was performed within 5 days and after six months. VCUG was performed after acute phase of UTI. The differences in TDT according to the presence of ASL, USF and VUR were assessed. And the correlation between ASL or USF with the duration of TDT was assessed. Of 230 patients enrolled, 142 patients had refluxing UTI and 88 patients had non-refluxing UTI. TDT was the risk factor associated with ASL and USF along with presence of VUR. TDT was longer in ASL positive group compared with the ASL negative group. Also USF group showed longer TDT compared with those without USF in both refluxing UTI and non refluxing UTI. The TDT was significantly shorter in USF group with the presence of VUR. Positive linear association was noted between prevalence of ASL and USF and duration of TDT. In conclusion, the impact of UTI on formation of USF may be enhanced by the presence of VUR with shorter duration of TDT.