TY - JOUR
T1 - A rapid plasma neutrophil gelatinase-associated lipocalin assay for diagnosis of acute pyelonephritis in infants with acute febrile urinary tract infections
T2 - A preliminary study
AU - Seo, Won Hee
AU - Nam, Seong Woo
AU - Lee, Eun Hee
AU - Je, Bo Kyung
AU - Yim, Hyung Eun
AU - Choi, Byung Min
N1 - Funding Information:
Acknowledgments This study was supported by the Korea University Hospital Hin Moe (Prof. Hyum-Gum Lee) Research Fund and Korea University Grant. We thank the physicians and nursing staff working in the pediatric general ward of Korea University Ansan Hospital for their enthusiastic support and cooperation.
PY - 2014/2
Y1 - 2014/2
N2 - In infants with febrile urinary tract infection (UTI), the accurate rapid diagnosis of acute pyelonephritis (APN) would be valuable because early aggressive treatment reduces the risk of renal scarring. The objective of the study was to evaluate whether rapid plasma neutrophil gelatinase-associated lipocalin (NGAL) assay could be used as a diagnostic biomarker of renal parenchymal injury in infants with acute febrile UTI to distinguish APN at the bedside. This prospective observational study included 47 infants, who were admitted with a first episode of acute febrile UTI. Total UTI group was divided into the Cortical defect (UTI-CD, n = 24) group and Non-cortical defect (UTI-ND, n = 23) group, according to the result of renal scan. For the Control group, 15 infants who presented a febrile episode without any focus of bacterial infection were included. On admission, the median NGAL level (106.5 [60-476] ng/mL) in the UTI-CD group was significantly higher than that (60 [60-196] ng/mL) in the UTI-ND group and that (60 [60-197] ng/mL) in the Control group and was significantly decreased to 60 [60-306] ng/mL after an antibiotic treatment. The area under the receiver operating characteristic curves was 0.748 (95 % CI, 0.610-0.887; P = 0.003) for NGAL levels and 0.724 (95 % CI, 0.579-0.868; P = 0.009) for CRP levels. The best cutoff of NGAL level for detection of APN was founded to be 61.0 ng/mL (sensitivity, 75.0 %; specificity, 78.3 %). Although not a stand-alone test, the rapid determination of plasma NGAL level provides valuable information quickly, concerning the distinction of APN, for determining the clinical course of acute febrile UTI.
AB - In infants with febrile urinary tract infection (UTI), the accurate rapid diagnosis of acute pyelonephritis (APN) would be valuable because early aggressive treatment reduces the risk of renal scarring. The objective of the study was to evaluate whether rapid plasma neutrophil gelatinase-associated lipocalin (NGAL) assay could be used as a diagnostic biomarker of renal parenchymal injury in infants with acute febrile UTI to distinguish APN at the bedside. This prospective observational study included 47 infants, who were admitted with a first episode of acute febrile UTI. Total UTI group was divided into the Cortical defect (UTI-CD, n = 24) group and Non-cortical defect (UTI-ND, n = 23) group, according to the result of renal scan. For the Control group, 15 infants who presented a febrile episode without any focus of bacterial infection were included. On admission, the median NGAL level (106.5 [60-476] ng/mL) in the UTI-CD group was significantly higher than that (60 [60-196] ng/mL) in the UTI-ND group and that (60 [60-197] ng/mL) in the Control group and was significantly decreased to 60 [60-306] ng/mL after an antibiotic treatment. The area under the receiver operating characteristic curves was 0.748 (95 % CI, 0.610-0.887; P = 0.003) for NGAL levels and 0.724 (95 % CI, 0.579-0.868; P = 0.009) for CRP levels. The best cutoff of NGAL level for detection of APN was founded to be 61.0 ng/mL (sensitivity, 75.0 %; specificity, 78.3 %). Although not a stand-alone test, the rapid determination of plasma NGAL level provides valuable information quickly, concerning the distinction of APN, for determining the clinical course of acute febrile UTI.
KW - Acute pyelonephritis
KW - Children and adolescents
KW - Infants
KW - NGAL
KW - Pediatric nephrology
KW - Urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=84897651216&partnerID=8YFLogxK
U2 - 10.1007/s00431-013-2112-6
DO - 10.1007/s00431-013-2112-6
M3 - Article
C2 - 23918295
AN - SCOPUS:84897651216
VL - 173
SP - 229
EP - 232
JO - Acta Paediatrica Hungarica
JF - Acta Paediatrica Hungarica
SN - 0340-6199
IS - 2
ER -