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Urinary proteins in children with urinary tract infection
Lena Andersson1, Iulian Preda, Mirjana Hahn-Zoric
1Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, P.O. Box 414, 405 30, Gothenburg, Sweden. lena.andersson@amm.gu.se
Insights
Urinary retinol-binding protein (RBP) and Clara cell protein (CC16) levels correlate with kidney damage in children with urinary tract infections (UTI). Urinary C-reactive protein (CRP) helps differentiate UTI from other infections.
Area of Science:
- Pediatric Nephrology
- Biomarker Discovery
- Infectious Diseases
Background:
- Urinary tract infections (UTI) are common in young children.
- Assessing renal damage in pediatric UTI is crucial.
- Biomarkers for early detection of kidney injury in UTI are needed.
Purpose of the Study:
- To investigate urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP), and Clara cell protein (CC16) in children with UTI.
- To determine the relationship between these urinary biomarkers and renal damage assessed by dimercaptosuccinic acid (DMSA) scintigraphy.
- To evaluate the utility of urinary CRP in differentiating UTI from other febrile conditions.
Main Methods:
- Study included 52 children under 2 years with UTI (44 febrile) and 23 controls with non-UTI infections.
- Renal damage assessed using DMSA scintigraphy (mild, moderate, severe).
- Urinary RBP, CC16, CRP, and A1M levels measured and correlated with DMSA findings.
Main Results:
- Significant association found between DMSA class and urinary RBP and CC16 excretion.
- Urinary CRP levels were significantly higher in UTI patients compared to controls.
- Urinary CRP excretion did not significantly correlate with DMSA class.
Conclusions:
- Urinary RBP and CC16 excretion strongly correlate with renal uptake defects on DMSA scans in children with UTI.
- Urinary CRP levels can help distinguish UTI from other febrile illnesses.
- Combined urinary biomarkers may aid in clinical assessment of pediatric UTI and associated renal damage.
Abstract:
The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels. Thirty-six patients had abnormal DMSA uptake, classified as mild, moderate or severe damage (DMSA class 1, 2, 3, respectively). There was a significant association between DMSA class and the excretion of urinary RBP (u-RBP) and u-CC16. There was also a significant difference in u-CRP levels between children with UTI and control children with non-UTI infections, although u-CRP excretion was not significantly correlated to DMSA class. In conclusion, the urinary excretion of the low-molecular-weight proteins RBP and CC16 showed a strong association with uptake defects on renal DMSA scans. The urinary level of CRP seems to distinguish between children with UTI and other febrile conditions. A combination of these biomarkers may be useful in the clinical assessment of children with UTI.
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