Akut pyelonefritte akut faz reaktanlarının tanısal ve prognostik değeri

Bu çalışma: C-reaktif protein (CRP), alfa-1-asit glikoprotein (AAG) ve haptoglobin (HPT) üçlü akut faz reaktan (AFR) testlerinin akut pyelonefrit (APN) tanısı ve renal skarı belirlemedeki değerini araştırmak amacı ile K.T.Ü. Tıp Fakültesi Pediatri Polikliniğine başvuran 30 APN ve 20 basit idrar yolu enfeksiyonlu (İYE) vakada gerçekleştirildi. Akut pyelonefritli vakalarda tedavinin başlangıcında ve 5. gününde eritrosit sedimentasyon hızı (ESH), CRP, AAG ve HPT ölçümleri ve ilki tanı anında, ikincisi ise tanıdan üç ay sonra olmak üzere iki kez DMSA-sintigrafı incelemesi yapıldı. Basit İYE vakalarında ise tedavinin başlangıcında ESH ve AFR analizleri ile ultrasonografik inceleme yapıldı. Akut pyelonefrit tanısı için CRP+AAG+HPT ve CRP+AAG birlikte pozitifliklerinin spesifıtesi ve pozitif belirleyicilik değerleri, tek başına CRP, AAG ve HPT'den daha yüksek bulundu. Skar gelişmeyen APN'li vakalarda başlangıçtaki CRP+AAG+HPT birlikte pozitiflik oranı tedavinin 5. gününde anlamlı derecede azalmış olmasına rağmen (p0.05). Tedavinin 5. gününde CRP+AAG+HPT birlikte pozitifliğinin skar gelişimini önceden belirlemedeki pozitif belirleyicilik değeri %67, spesifitesi %83 idi. Bu sonuçlar APN tanısının doğrulanmasında CRP+AAG+HPT üçlü testinin kullanılabileceğini ve tedavinin 5. gününde bu üçlü test pozitifliğinin sebat etmesinin renal skar gelişiminin ön habercisi olabileceğinin düşündürmektedir.

Prognostic and diagnostic value of acute phase reactants acute pyelonephritis

This study was carried out to determine the availability of triple acute phase reactants (APR) test [C-reactive protein (CRP), alpha-1-acid glycoprotein (AAG) haptoglobin (HPT) ] in the diagnosis of acute pyelonephritis (APN) and the development of renal scarring in APN. Fifty patients, 30 with acute pyelonephritis and 20 with simple urinary tract infections (UTI) were enrolled to the study. In APN group the erythrocyte sedimentation rate (ESR), CRP, AAG and HPT were measured before and at the fifth day of treatment, and a DMSA- scintigraphy was performed in the acute period and at least three months after treatment, hi simple UTI group the ESR and APR were measured, and an abdominal ultrasonography was performed at the beginning of the treatment. The specificity and positive predictive values of CRP+AAG+HPT and CRP+AAG were higher than CRP, AAG or HPT alone, for the diagnosis of acute pyelonephritis. The positivity rate of CRP+AAG+HPT was significantly decreased at the fifth day of treatment when compared with the pretreatment values in the group without scarring where, the difference was not significant in the group with scarring. The positive predictive value and specificity of CRP+AAG+HPT at the fifth day of treatment for estimating scarring development were 67%, and 83%, respectively. Our results indicate that CRP+AAG+HPT triple test is useful and reliable for the diagnosis of APN and perseverance of positivity of triple test at the fifth day of treatment may point out scarring formation.

Kaynakça

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