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Microalbuminuria: an index of severity in childhood meningitis
1Hospital Luis Calvo Mackenna, University of Chile, Santiago.
Abstract:
Urinary albumin excretion (AE) was determined by a sensitive method (below dipstick positive values, 15 to 300 micrograms/minute) in 68 children with meningitis during 48 hours after hospital admission; 51 children had bacterial meningitis (BM) and 17 had aseptic meningitis. AE (results as mean +/- SD) during 0 to 24 hours was higher (P < 0.001) in patients with BM (36 +/- 40 micrograms/minute) than with aseptic meningitis (7 +/- 5 micrograms/minute), albeit no cutoff value distinguished the two conditions accurately. In BM the clinical course (uneventful, intermediate, complicated, fatal) correlated with AE of 0 to 24 hours (r = 0.34, P < 0.05) and AE of 25 to 48 hours (r = 0.63, P < 0.001). Cerebrospinal fluid protein concentration 24 to 36 hours after initiation of treatment correlated with AE of 25 to 48 hours (r = 0.34, P < 0.05). An index obtained by dividing AE by the weight of the child predicted the severity of clinical course more precisely (77% sensitivity, 85% specificity) than AE alone. Hence renal AE is an easily and non-invasively determined acute phase reactant of potential value as an early estimate of severity of BM.
Insights
Urinary albumin excretion (AE) is higher in children with bacterial meningitis (BM) than aseptic meningitis. AE can help predict the severity of BM, offering an early, non-invasive assessment.
Area of Science:
- Nephrology
- Pediatrics
- Infectious Diseases
Background:
- Meningitis is a serious infection affecting the central nervous system.
- Early assessment of disease severity in pediatric meningitis is crucial for timely intervention.
- Urinary albumin excretion (AE) is a sensitive indicator of kidney function and potential marker of systemic illness.
Purpose of the Study:
- To investigate urinary albumin excretion (AE) in children with meningitis.
- To determine if AE can differentiate between bacterial meningitis (BM) and aseptic meningitis.
- To assess the correlation between AE and the clinical course and severity of BM.
Main Methods:
- Urinary albumin excretion (AE) was measured in 68 children with meningitis (51 BM, 17 aseptic) within 48 hours of admission.
- AE levels were analyzed in relation to diagnosis, clinical course (uneventful to fatal), and cerebrospinal fluid protein concentration.
- A predictive index for clinical severity was derived by dividing AE by child's weight.
Main Results:
- Children with BM exhibited significantly higher AE (36 ± 40 µg/min) compared to those with aseptic meningitis (7 ± 5 µg/min).
- AE during 0-24 hours and 25-48 hours correlated with the clinical course of BM (r=0.34, P<0.05 and r=0.63, P<0.001, respectively).
- A weight-adjusted AE index demonstrated higher precision (77% sensitivity, 85% specificity) in predicting BM severity than AE alone.
Conclusions:
- Renal AE serves as a valuable, non-invasive acute phase reactant in pediatric meningitis.
- AE measurements can provide an early estimation of bacterial meningitis severity.
- Further research may establish AE as a routine biomarker for assessing pediatric meningitis outcomes.