Predictors of Acute Pyelonephritis in Infants Less Than 4 Months Old with Febrile Urinary Tract Infection (original) (raw)
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The Malaysian journal of medical sciences : MJMS, 2013
The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran. This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children's hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results. Within the study population, 72 p...
The Accuracy of Interleukin-6 Urine Compared to Urine Culture to Diagnose Pyelonephritis in Neonates
JOJ Urology & Nephrology, 2017
Introductıon Urinary tract infection is an infection that is often encountered in children in all groups of age, including the newborn period [1]. Based on the research at Cipto Mangunkusumo Hospital in 2004, the prevalence of urinary tract infection in neonates 14.9% [2], where the boy was more dominant compared with girl (between 2:1 and 6:1) because the possibility of an increasing incidence of structural abnormalities. In the group of preterm neonates, the prevalence ranges from 4% to 25%. Early diagnose is very important to maintain the function of the developing kidney. On infants these symptoms typically got fever, irritability or other symptoms such as lethargy [3]. Accurate diagnose and early treatment of pyelonephritis are important because the risk of renal scarring, hypertension and renal failure. It is important to distinguish the upper urinary tract infections and lower part, due to involvement of the renal parenchyma which can lead to kidney failure and chronic renal failure harvesters [4]. The diagnosis of urinary tract infection must be implementedby urine culture. Various investigations can be done to help making a diagnose such as leukocyte esterase, nitriurin, leukocytosis, an increasing the absolute value of neutrophils, an increasing erythrocyte sedimentation rate, C-reactive protein (CRP), procalsitonin level, tumor necrosis factor-α (TNF-α), IL-6 urine, and Interleukin-1β (IL-1β) [5]. An increasing number of IL-6 urine is useful as a quick examination occurrence of pyelonephritis. This is very useful especially in the case of pyelonephritis in which the clinical manifestations seldom apparent, therefore, with a rapid examination and accurate results then the treatment of pyelonephritis can be rapidly established and treated so that complications such as renal scarring, which can lead to hypertension and renal insufficiency can be avoided [6].
Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger
Pediatrics, 2018
Reports of the test accuracy of the urinalysis for diagnosing urinary tract infections (UTIs) in young febrile infants have been variable. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, in young febrile infants. We performed a planned secondary analysis of data from a prospective study of febrile infants ≤60 days old at 26 emergency departments in the Pediatric Emergency Care Applied Research Network. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, by using 2 definitions of UTI: growth of ≥50 000 or ≥10 000 colony-forming units (CFUs) per mL of a uropathogen. We defined a positive urinalysis by the presence of any leukocyte esterase, nitrite, or pyuria (>5 white blood cells per high-power field). Of 4147 infants analyzed, 289 (7.0%) had UTIs with colony counts ≥50 000 CFUs/mL, including 27 (9.3%) with bacteremia. For these UTIs, a positive uri...
Procalcitonin: A Marker of Severity of Acute Pyelonephritis Among Children
The Journal of Urology, 2005
Objective. Febrile urinary tract infection (UTI) is a common problem among children. The diagnosis and management of acute pyelonephritis is a challenge, particularly during infancy. The distinction between acute pyelonephritis and UTI without renal involvement is very important, because renal infection may cause parenchymal scarring and thus requires more aggressive investigation and follow-up monitoring. However, this distinction is not easy among children, because common clinical findings and laboratory parameters are nonspecific, especially among young children.
The Journal of Urology, 2013
Purpose-The American Academy of Pediatrics no longer recommends a voiding cystourethrogram (VCUG) for children aged 2 to 24 months presenting with their first urinary tract infection (UTI) if renal-bladder ultrasound (RBUS) is normal. Our goal was to identify factors associated with abnormal imaging and recurrent pyelonephritis for this population. Materials and Methods-We retrospectively evaluated children diagnosed with first episode of pyelonephritis between 2 to 24 months using de-identified electronic medical record data from an institutional database. Data included age at first UTI, gender, race/ethnicity, need for hospitalization, intravenous antibiotic use, history of abnormal prenatal ultrasound, RBUS and VCUG results, UTI recurrence and surgical intervention. Risk factors for abnormal imaging and UTI recurrence were analyzed with univariate logistic regression, chi square and survival analysis. Results-We identified 174 patients. Of 154 RBUS performed, 59 (38%) were abnormal. Abnormal prenatal ultrasound (p=0.01) and need for hospitalization (p=0.02) predicted abnormal RBUS. Of the 95 patients with normal RBUS, 84 had a VCUG. Vesicoureteral reflux was more likely in Caucasians (p=0.003), females (p=0.02) and older patients (p=0.04). Despite normal RBUS, 23 of 84 (24%) patients had dilating vesicoureteral reflux. Of the 95 patients with normal RBUS, 14 (15%) had recurrent pyelonephritis and 7 (7%) went on to surgical intervention. Conclusions-Despite a normal RBUS after first episode of pyelonephritis, a child may still have vesicoureteral reflux, recurrent pyelonephritis, and need for surgical intervention. If VCUG is deferred, parents should be counseled regarding these risks.
International braz j urol : official journal of the Brazilian Society of Urology
To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI). This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. UIL-...
Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2015
Objective: Urinary tract infections (UTIs) are one of the most common causes of acute fever without a focus in children between 1-36 months old, although obtaining urine for urine analysis is technically difficult in this age group. Therefore, there is a need for clinical and laboratory evidence to predict UTIs. The aim of this study is to determine the frequency of urinary tract infections in children between 1-36 months with acute fever of without a focus and the laboratory evidence, like C-reactive protein, procalcitonin, and interleukin-6 levels, that would help to predict urinary tract infections. Material and Methods: Febrile children presenting to a pediatric emergency department, ages ranging between 1-36 months old and body temperature being ≥38.0°C, with a source of fever that was undetectable clinically, were enrolled in this prospective study. Patients were evaluated according to clinical and laboratory findings. The data were analyzed using SPSS software, version 15.0. Results: A total of 90 patients were enrolled in this study. The median age was 7 months. The frequency of urinary tract infections was 25%. Escherichia coli was detected in all cases with positive urine cultures. There was no difference in clinical features between children with and without urinary tract infections. Laboratory findings, including white blood cell count, absolute neutrophil count, peripheral blood smear, and interleukin-6, were not statistically different between the two groups, whereas C-reactive protein and procalcitonin levels were significantly higher in the UTI group (p<0.05). Conclusion: In conclusion, UTI is a frequent infection in 1-36-month-old children with fever without a focus, and the urine test with urine culture must certainly be assessed in these children. Laboratory findings, including C-reactive protein and procalcitonin, can be used as supporting evidence. There is a need for large trials evaluating the value of interleukin-6 levels to predict urinary tract infections in children.(
Urinary Tract Infection in Febrile Infants Younger Than Eight Weeks of Age
Pediatrics, 2000
Objective. To assess the usefulness of laboratory parameters, including peripheral white blood cell (WBC) count, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and microscopic urinalysis (UA), for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection (UTI), and comparison of standard UA and hemocytometer WBC counts for predicting the presence of UTI. Methods. A total of 162 febrile children <8 weeks of age were enrolled in this prospective study. All underwent clinical evaluation and laboratory investigation, including WBC count and differential; ESR; CRP; blood culture; a lumbar puncture for cell count and differential, glucose level, protein level, Gram stain, and culture; and a UA and urine culture. All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with standard UA as well as with hemocytometer WBC counts. Quantitative urine cultures were performed. Sensitivity, specifici...