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Urine interleukin-6, interleukin-8 and transforming growth factor β1 in infants with urinary tract infection and
Grażyna Krzemień1, Agnieszka Szmigielska1, Agnieszka Turczyn1
1Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland.
Insights
In infants, higher urine interleukin-6 (IL-6) and IL-8 levels indicate febrile urinary tract infections (UTIs) compared to asymptomatic bacteriuria (ABU). These markers, along with transforming growth factor beta-1 (TGF-β1), help differentiate infection severity in children.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Biochemistry
Background:
- Urinary tract infections (UTIs) are common in infants, affecting 1.1-1.4%.
- Asymptomatic bacteriuria (ABU) is found in 0.9-2.5% of infants.
- Distinguishing febrile UTI, non-febrile UTI, and ABU is crucial for appropriate management.
Purpose of the Study:
- To evaluate the diagnostic utility of urine pro-inflammatory cytokines (IL-6, IL-8) and anti-inflammatory cytokine (TGF-β1).
- To assess these markers in infants with febrile UTI, non-febrile UTI, and ABU.
- To correlate cytokine levels with systemic inflammatory markers and renal imaging findings.
Main Methods:
- Study included 35 infants divided into febrile UTI (n=13), non-febrile UTI (n=13), and ABU (n=9) groups.
- Measured urine IL-6, IL-8, TGF-β1, and serum CRP, ESR, WBC.
- Renal ultrasound, DMSA scintigraphy, and VCUG were performed as indicated.
Main Results:
- Urine IL-6 and IL-8 were significantly higher in febrile UTI vs. non-febrile UTI and ABU (p<0.01).
- Urine TGF-β1 was higher in febrile UTI vs. ABU (p<0.05).
- IL-8 and TGF-β1 showed potential cutoff values for detecting inflammatory changes on DMSA scans.
Conclusions:
- Urine IL-6, IL-8, and TGF-β1 levels differ significantly between febrile UTI and ABU in infants.
- These urine cytokines and systemic markers do not distinguish between upper and lower UTIs in this age group.
Introduction:
Urinary tract infection (UTI) occurs in 1.1% of girls and 1.4% of boys during the first year of life. Asymptomatic bacteriuria (ABU) is usually detected incidentally in 0.9% of girls and 2.5% of boys at this age. The aim of the study was to assess the usefulness of measurement of pro-inflammatory urine interleukin (IL)-6 and IL-8 concentrations and anti-inflammatory transforming growth factor β1 (TGF-β1) level in infants with febrile UTI, non-febrile UTI and ABU.
Material And Methods:
A total of 35 children, mean age 6.14 ±3.47 months, were divided into three groups: group I - febrile UTI (n = 13), group II - non-febrile UTI (n = 13) and group III - ABU (n = 9). At the time of enrollment urine IL-6, IL-8, TGF-β1 and serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were measured. Renal ultrasound was performed in all children, 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) and voiding cystourethrography in children with UTI.
Results:
Urine concentrations of IL-6 and IL-8 were significantly higher in febrile UTI compared to those with non-febrile UTI and ABU (p < 0.5, p < 0.01) and positively correlated with CRP, ESR and WBC (p < 0.01). Urine levels of TGF-β1 were significantly higher in children with febrile UTI compared to those with ABU (p < 0.05) and positively correlated with WBC (p < 0.01). Inflammatory changes in the DMSA scan were detected in 66.6% of children with UTI. No significant difference in frequency of an abnormal DMSA scan compared to a normal scan was found in groups with febrile and non-febrile UTI. No relations between urine cytokines, systemic inflammatory markers and changes in DMSA scan were observed. The cutoff value for detection of inflammatory changes in the DMSA scan for IL-8 was 120 pg/mg creatinine (Cr) and 40 pg/mg Cr for TGF-β1. Based on this value, the sensitivity for IL-8 was 58.3%, specificity 100% and for TGF-β1 66.7% and 83.7%, respectively.
Conclusions:
We found significant differences in children with febrile UTI and ABU regarding urine IL-6, IL-8 and TGF-β1 levels. Urine cytokines and systemic inflammatory markers do not differentiate between upper and lower UTI in infants.
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