THE ROLE OF PROCALCITONIN IN THE EARLY DETECTION OF URINARY TRACT INFECTIONS WITH RENAL PARENCHYMAL INVOLVEMENT IN CHILDREN
Background: Urinary tract infections (UTIs) are common childhood infections that may involve the renal parenchyma followed by late scarring. Early diagnosis and management of these infections can prevent renal scarring. Currently, dimercaptosuccinic acid (DMSA) scanning is the clinical gold standard to identify renal scarring but is not routinely performed. A more accessible assay could therefore prove useful. Thus, we aimed to evaluate the sensitivity and specificity of procalcitonin (PCT) in comparison with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), using DMSA scan as reference, in the early detection of renal parenchymal involvement in children. Methods: In this cross-sectional study, 104 patients aged 1 month to 18 years, admitted to Bandar Abbas Pediatric Hospital from 2012 to 2015, due to their first episode of UTI were evaluated. UTI was confirmed by urine culture. Serum PCT, CRP, ESR and leukocyte count (LC) were measured before the initiation of antibiotic therapy. DMSA scan was performed during the first week of hospitalization and was considered as a reference for the detection of renal scarring. The receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of the biomarkers for the detection of renal parenchymal involvement. Results: Mean PCT, CRP, ESR and LC of patients with parenchymal involvement were significantly higher compared to those without parenchymal involvement (P<0.001). PCT ?1 ng/ml, CRP ?1.5 mg/L, and ESR ?30 mm/h were 100% sensitive for the early detection of renal parenchymal involvement. Their specificity was 88.3%, 100%, and 97.1%, respectively. Conclusions: Serum PCT, CRP and ESR are all strong markers for the early detection of renal parenchymal involvement in UTI. However, the specificity of CRP is higher than PCT and ESR.[Full Text Article]
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