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Urine macrophage migration inhibitory factor (MIF) in children with urinary tract infection: a possible predictor of

Hasan Otukesh1, Seyed-Mohammad Fereshtehnejad, Rozita Hoseini

  • 1Urology and Nephrology Research Center, Labbafi Nejad Hospital, Tehran, Iran.

Pediatric Nephrology (Berlin, Germany)
|September 19, 2008
PubMed

Insights

The urine Macrophage Migration Inhibitory Factor (MIF) to creatinine ratio can non-invasively differentiate upper and lower urinary tract infections in children. Higher ratios indicate a greater risk of kidney scarring from pyelonephritis.

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Biomarker Discovery

Background:

  • Macrophage Migration Inhibitory Factor (MIF) is a pro-inflammatory cytokine found at inflammation sites.
  • Urinary tract infections (UTIs) require methods to distinguish upper (pyelonephritis) from lower (cystitis) involvement.
  • Differentiating UTI types is crucial for timely and appropriate treatment to prevent renal damage.

Purpose of the Study:

  • To evaluate urinary MIF concentration as a non-invasive biomarker for differentiating pediatric pyelonephritis from cystitis.
  • To assess the utility of the urine MIF/creatinine (Cr) ratio in identifying patients at risk for renal scarring.
  • To establish a sensitive diagnostic marker for upper UTIs in children.

Main Methods:

  • A prospective case-control study involving 33 pediatric UTI patients and 40 healthy controls.
  • Pyelonephritis diagnosis confirmed by dimercaptosuccinic acid (DMSA) scan.
  • Urinary MIF concentration measured via enzyme-linked immunosorbent assay (ELISA), with results normalized to creatinine.

Main Results:

  • The urine MIF/Cr ratio was significantly elevated in pyelonephritis patients compared to cystitis and control groups (P < 0.001).
  • An optimal cut-point of 4.90 pg/micromol Cr for the urine MIF/Cr ratio demonstrated potential for differentiating pyelonephritis from cystitis.
  • Higher urine MIF/Cr ratios correlated with the development of renal scars on follow-up DMSA scans in pyelonephritis patients.

Conclusions:

  • The urine MIF/Cr ratio serves as a sensitive biomarker for distinguishing acute pyelonephritis from acute cystitis in children.
  • This ratio aids in identifying pediatric patients with pyelonephritis who are at higher risk for developing permanent renal scars.
  • Urinary MIF assessment offers a valuable, non-invasive tool for pediatric UTI management and prognosis.

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