Procalcitonin: a key marker in children with urinary tract infection
Sandrine Leroy1, Alain Gervaix
1Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Linton Road, Oxford OX2 6UD, UK.
Insights
Procalcitonin shows promise in diagnosing kidney infections and reflux in children with urinary tract infections (UTIs). This marker may help determine the need for further imaging tests like DMSA scans or cystography.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Biomarkers
Background:
- Urinary tract infections (UTIs) are common in febrile children.
- Accurate diagnosis of acute pyelonephritis (APN) and vesicoureteral reflux (VUR) is crucial to prevent renal scarring and long-term complications.
- Current gold standard diagnostics (DMSA scan, cystography) have limitations.
Purpose of the Study:
- To evaluate procalcitonin as a diagnostic marker for APN and VUR in children.
- To explore procalcitonin's role in predicting renal scarring and high-grade VUR.
- To assess procalcitonin's utility in guiding diagnostic decisions after a UTI.
Main Methods:
- Review of existing literature on procalcitonin in pediatric UTIs.
- Analysis of procalcitonin's correlation with APN, renal scarring, and VUR.
- Evaluation of procalcitonin's role in clinical decision-making algorithms.
Main Results:
- Procalcitonin is a reliable marker for bacterial infections and predicts renal parenchymal involvement.
- Procalcitonin is associated with renal scarring and high-grade VUR.
- Procalcitonin aids in predicting high-grade VUR in children with their first UTI.
Conclusions:
- Procalcitonin demonstrates significant potential in the diagnosis and management of pediatric UTIs.
- It may help refine the selection of imaging studies, reducing the need for invasive procedures.
- Further research is warranted to fully integrate procalcitonin into clinical practice for pediatric UTI evaluation.
Abstract:
Urinary tract infections (UTIs) are the most common source of bacterial infections among young febrile children. Accurate diagnosis of acute pyelonephritis (APN) and vesicoureteral reflux (VUR) is important because of their association with renal scarring, leading in the cases to long-term complications. However, the gold standard examinations for both are either DMSA scan (for APN and scar) or cystography (for VUR) and present limitations (feasibility, pain, cost, etc.). Procalcitonin, a reliable marker of bacterial infections, was demonstrated to be a good predictor of both renal parenchymal involvement in the acute phase and late renal scars. Furthermore, it was also found to be associated with high-grade VUR and was the key tool of a clinical decision rule to predict high-grade VUR in children with a first UTI. Therefore, procalcitonin may certainly be found playing a role in the complex and still debated picture of which examination should be performed after UTI in children.
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