Çagla SARITÜRK, Esra BASKIN, Buket KILIÇASLAN, Aytül NOYAN, Nurcan CENGİZ, Gönül PARMAKSIZ

Can We Differentiate Pyelonephritis and Cystitis without 99mTc-Dimercaptosuccinic Acid Scan in Children?

Amaç: İdrar yolu enfeksiyonu, çocukluk çağının en sık görülen enfeksiyonlarından biridir. Piyelonefritin uzun dönemde görülen sekelleri nedeniyle sistitten ayırımı önemlidir. Bu çalışmanın amacı, çocuklarda 99mTc-Dimerkaptosüksinik Asid ile sintigrafik görüntüleme yapılmaksızın piyelonefrit ayırımını yapmakta prokalsitonin ve C-Reaktif Protein gibi belirteçlerin tanısal değerini saptamak, 99mTc-Dimerkaptosüksinik Asid ile sintigrafik görüntüleme yapılacak hastalar konusunda yol gösterici olup olmayacağını belirlemektir. Materyal ve Metod: Bu çalışmaya, 3 ay ile 16 yaş arasında, ilk kez idrar yolu enfeksiyonu geçiren 50 çocuk dahil edilmiştir. Retrospektif gözleme dayalı bir çalışmadır. Piyelonefrit tanısı için serum C-Reaktif Protein ve prokalsitonin düzeylerinin ortanca değeri, duyarlılık, özgüllük ve cut-off değerleri saptandı. Bulgular: Hastaların 32'si (%64) piyelonefrit tanısı alırken, 18 (%36) hasta sistit tanısı aldı. Piyelonefrit tanısı için CReaktif Protein cut-off değeri %69 duyarlılık ve %61 özgüllük ile 34 mg/L iken, prokalsitonin için bu değer %69 duyarlılık ve %66 özgüllük ile 0,23 ng/mL saptandı. Her iki belirteçin birlikte kullanılması ise %63 duyarlılık ve %78 özgüllük ile piyelonefrit tanısını destekledi. Sonuç: Çocuklarda piyelonefrit tanısını koymakta serum prokalsitonin ve C-Reaktif Proteinin birlikte değerlendirilmesi, 99mTc-Dimerkaptosüksinik Asid ile sintigrafik görüntüleme yapılacak hastalarda yol gösterici olabilir. Böylece çocuklar 99mTc-Dimerkaptosüksinik Asid ile sintigrafik görüntülemenin dezavantajlarından uzak tutulabilir.

Çocuklarda Yapılmaksızın Piyelonefrit ve Sistit Tanısı Ayırt Edilebilir mi? 99mTc-Dimerkaptosüksinik Asid ile Sintigrafik Görüntü

Purpose: Urinary tract infection is one of the most common infections in childhood. Because of the long term sequelae, differentiation of pyelonephritis from cystitis is important. The aim of this study is to determine the value of biomarkers such as C-reactive protein and procalcitonin and whether preferred to predict pyelonephritis in children without 99mTcDimercaptosuccinic Acid scan. Material and Methods: Fifty children aged 3 months to 16 years with a first urinary tract infection were included in this retrospective observational study. The medians, sensitivity, specificity, and cut-off values of serum C - reactive protein and procalcitonin to predict pyelonephritis were determined. Results: Thirty-two (64%) patients were diagnosed with pyelonephritis and 18 (36%) were diagnosed with cystitis. The cut-off value for C - reactive protein was 34 mg/L to predict pyelonephritis, with 69% sensitivity and 61% specificity. The cut-off value for procalcitonin was 0.23 ng/mL to predict pyehlonephritis, with 69% sensitivity and 66% specificity. In combination, these biomarkers were 63% sensitive and 78% specific to predict pyelonephritis. Conclusion: Using a combination of procalcitonin and C-Reactive Protein is preferred to predict pyelonephritis in children, instead of the 99mTc-Dimercaptosuccinic Acid scan. Because of its disadvantages, the 99mTcDimercaptosuccinic Acid scan should be avoided in children.

PDF

___

1. American Academy of Pediatrics. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103:843-52.
2. Ammenti A, Cataldi L, Chimenz R, et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta-Paediatr. 2012;10:451-7.
3. Glauser MP, Lyons JM, Braude AI. Prevention of chronic experimental pyelonephritis by suppression of acute suppuration. J Clin Invest. 1978;61:403-7.
4. Bek K, Akman S, Bilge I, et al. Chronic kidney disease in children in Turkey. Pediatr Nephrol. 2009;24:797-806.
5. Jodal U, Lindberg U. Guidelines for management of children with urinary tract infection and vesicoureteral reflux. Recommendation from Swedish state of the art conference. Acta Paediatr. 1999;431:87-9.
6. Rushton HG. The evaluation of acute pyhelonephritis and renal scarring with technetium 99mdimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol. 1997;11:108-20.
7. Pecile P, Mirion E, Romanello C, et al. Procalcitonin: A marker of severity of acute pyelonephritis among children. Pediatrics. 2004;114: 249-54.
8. Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515-8.
9. Garin EH, Olavarria F, Araya C, et al. Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol. 2007;22:1002-6.
10. Jacobsson SH, Eklof O, Eriksson CG, et al. Development of hypertension and uremia after pyelonephritis in childhood:27 year follow-up. BMJ. 1989;299:703-6.
11. Biggi A, Dardanelli L, Pomero G, et al. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatric Nephrol. 2001;16:733-8.
12. Benador N, Siegrist CA, Gendrel D, et al. Procalcitonin is a marker of severity of renal lesions in pyelonephritis. Pediatrics. 1998;102:1422-5.
13. Gürgöze MK, Akarsu S, Yılmaz E, et al. Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis. Pediatr Nephrol. 2005;20:1445-8.
14. Smolkin V, Koren A, Raz R, et al. Procalcitonin as a marker of acute pyelonephritis in infants and children. Pediatr Nephrol. 2002;17:409-12.
15. Nikfar R, Khotaee G, Ataee N, Shams S. Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department. Pediatr Int. 2010;52:196-8.
16. Ayazi P, Mahyar A, Hashemi HJ, et al. Comparison of procalcitonin and C-reactive protein tests in children with urinary tract infection. Iran J Pediatr. 2009;19:381-6.
17. Güven AG, Kazdal HZ, Koyun M, et al. Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin? Nucl Med Commun. 2006;27:715-21.
18. Tuerlinckx D, Borght TV, Glupczynski Y, et al. Is procalcitonin a good marker of renal lesion in febrile urinary tract infection? Eur J Pediatr. 2005;164:651-2.
19. Bigot S, Leblond P, Foucher C, et al. Usefulness of procalcitonin for the diagnosis of acute pyelonephritis in children. Arch Pediatr. 2005;12:1075-80.
20. Karavanaki K, Haliotis FA, Sourani M, et al. DMSA scintigraphy in febrile urinary tract infections could be omitted in children with low procalcitonin levels. Infect Dis Clin Prac. 2007;15:377-81.
21. Kotoula A, Gardikis S, Tsalkidis A, et al. Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection. Urology. 2009;73:782-6.
22. Gervaix A, Galetto-Lacour A, Gueron T, et al. Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J. 2001;20:507-11.
23. Prat C, Dominguez J, Rodrigo C, et al. Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection. Pediatr Infect Dis J. 2003;22:438-42.