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Procalcitonin and minimal-change nephropathy: a pilot study
Onur Sakallioglu1, Ugur Musabak, Suleyman Kalman
1Paediatric Nephrology Unit, Gulhane Military Academy of Medicine, Ankara, Turkey. onursakallioglu@hotmail.com
Introduction:
This study assessed the role of procalcitonin (PCT) in the differentiation of minimal-change nephropathy (MCN) relapses from infections co-existent with proteinuria flares in children.
Methods:
Data on the PCT levels of patients with MCN who were on follow-up were retrospectively gathered at relapse (Group I), during proteinuria attacks co-existent with intercurrent infection (Group II) and at remission (Group III). The results of these three groups were then prospectively compared with nephrologically healthy patients who had infections that were similar to those in Group II (Group IV), and controls (Group V).
Results:
Significant differences in PCT level were noted between patients of Groups I, II and IV and the other two groups. A 93% reduction in proteinuria was achieved for Group II patients following an antibiotic regimen. The difference in PCT level between Groups I and II was significant. PCT showed a higher diagnostic predictability than C-reactive protein (CRP) in Group I patients, and was as good as CRP for those with infection and infection-related proteinuria. Sensitivity × specificity in relapse and infection-related states for PCT were 0.472 and 0.628, respectively, and those for CRP were 0.183 and 0.762, respectively.
Conclusion:
A combined approach with CRP and PCT readings may be beneficial in discriminating proteinuria attacks co-existent with intercurrent infection from sole relapses of nephrotic syndrome. PCT may be a part of the wide spectrum of immune abnormalities seen in patients with MCN.
Insights
Procalcitonin (PCT) helps differentiate minimal-change nephropathy (MCN) relapses from infections in children. Combining PCT with C-reactive protein (CRP) aids in distinguishing infection-related proteinuria from MCN relapses.
Area of Science:
- Pediatric Nephrology
- Clinical Immunology
Background:
- Minimal-change nephropathy (MCN) is a common cause of nephrotic syndrome in children.
- Differentiating MCN relapses from infections with proteinuria flares is clinically challenging.
- Procalcitonin (PCT) is a biomarker investigated for its role in infection and inflammation.
Purpose of the Study:
- To assess the utility of procalcitonin (PCT) in distinguishing minimal-change nephropathy (MCN) relapses from concurrent infections in pediatric patients.
- To compare the diagnostic performance of PCT with C-reactive protein (CRP) in these clinical scenarios.
Main Methods:
- Retrospective and prospective data collection of PCT levels in children with MCN at different stages: relapse, proteinuria with infection, and remission.
- Comparison with healthy children experiencing infections and controls.
- Analysis of PCT and CRP diagnostic accuracy (sensitivity x specificity).
Main Results:
- Significant differences in PCT levels were observed between MCN relapse/infection groups and remission/control groups.
- PCT demonstrated higher diagnostic predictability than CRP in MCN relapses.
- PCT showed comparable performance to CRP in differentiating infection-related proteinuria.
Conclusions:
- A combined approach using PCT and CRP may improve the discrimination between infection-induced proteinuria and sole MCN relapses.
- PCT may reflect the broader immune dysregulation associated with MCN.
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