Korean Journal of Pediatrics 2006;49(1):87-92.
Published online January 15, 2006.
Usefulness of serum procalcitonin test for the diagnosis of upper urinary tract infection in children
Dong Wook Kim1, Ju Young Chung1, Ja Wook Koo1, Sang Woo Kim1, Tae Hee Han2
1Department of Pediatrics Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
2Department of Diagnostic Laboratory Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
소아 상부 요로감염의 진단을 위한 혈청 procalcitonin 검사의 유용성
김동욱1, 정주영1, 구자욱1, 김상우1, 한태희2
1인제대학교 의과대학 상계백병원 소아과
2인제대학교 의과대학 상계백병원 진단검사의학과
Correspondence: 
Ja Wook Koo, Email: koojw9@sanggyepaik.ac.kr
Abstract
Purpose
: It is difficult to make a distinction between lower urinary tract infection(UTI) and acute pyelonephritis(APN) during the acute phase of febrile UTI due to nonspecific clinical symptoms and laboratory findings, especially among young children. We measured the serum procalcitonin(PCT) in children with UTI to distinguish between acute pyelonephritis and lower UTI, and to determine the accuracy of PCT measurement compared with other inflammatory markers.
Methods
: Serum samples were taken from children who admitted with unexplained fever or were suspected of having UTI. 51 children(mean 12.2?1.4 months) were enrolled in this study. Leukocyte counts, erythrocyte sedimentation rates(ESR) and C-reactive protein(CRP) were also measured. Renal parenchymal involvement was assessed by 99mTc DMSA scintigraphy in the first 7 days after admission. PCT was measured by immunoluminometric assay.
Results
: PCT values were significantly correlated with the presence of renal defects in children with UTI(n=16)(5.06?2.97 g/L, P<0.05). However, PCT values were not significantly different between children with UTI without renal damage(n=18) and children without UTI(n=17). Using a cutoff of 0.5 g/L for PCT and 20 mm/hr for ESR, 20 mg/L for CRP, sensitivity and specificity in distinguishing between UTI with and without renal involvement were 81.3 percent and 88.9 percent for PCT 87.5 percent and 72.2 percent for ESR, and 87.5 percent and 55.6 percent for CRP, respectively. Positive and negative predictive values were 86.7 percent and 84.2 percent for PCT and 60.9 percent and 81.8 percent for CRP, respectively.
Conclusion
: In febrile UTI, PCT values were more specific than CRP, ESR and leukocyte count for the identification of patients who might develop renal defects.
Key Words: Acute pyelonephritis , Procalcitonin , 99mTc DMSA scintigraphy , Urinary tract infection


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