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Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection
Author(s) -
Koufadaki AM,
Karavanaki KA,
Soldatou A,
Tsentidis Ch,
Sourani MP,
Sdogou T,
Haliotis FA,
Stefanidis CJ
Publication year - 2014
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.12706
Subject(s) - medicine , procalcitonin , urinary system , gastroenterology , white blood cell , c reactive protein , dimercaptosuccinic acid , absolute neutrophil count , neutropenia , inflammation , sepsis , toxicity
Aim To evaluate the predictive value of various clinical and laboratory parameters on the identification of acute extensive and/or multifocal renal involvement in children with febrile urinary tract infections ( UTI ). Methods The medical records of 148 children (median age: 2.4 months, range: 11 days–24 months), who were admitted during a 3‐year period with a first episode of febrile UTI , were analysed. Acute dimercaptosuccinic acid scintigraphy (DMSA), clinical and laboratory parameters were evaluated. Results Seventy six children (51%) had abnormal findings on the acute DMSA. Of them, 20 had DMSA grade 2, while 56 had grade 3 and 4. Patients with a DMSA grade 3 and 4 were more likely to have shivering (OR 3.4), white blood count (WBC) ≥ 18 000/ μ L (OR 2.4), absolute neutrophil count (ANC) ≥ 9300/ μ L (OR 4.4), C‐reactive protein (CRP) ≥ 50 mg/L (OR 2.7) and procalcitonin (PCT) ≥ 1.64 ng/mL (OR diagnostic). There was a significant difference of WBC (p = 0.004), ANC, CRP and PCT levels (p < 0.001) between children with normal and grade 2 aDMSA versus those with aDMSA grade 3 and 4. Conclusions Shivering and elevated inflammatory markers increase the risk of acute extensive and/or multifocal kidney involvement in children with febrile UTI . Procalcitonin seems to be an excellent marker of the severity of acute parenchymal involvement.