Procalcitonin as a predictor of renal scarring in infants and young children

Silvia Bressan, Barbara Andreola, Pietro Zucchetta, Giovanni Montini, Marta Burei, Giorgio Perilongo, Liviana Da Dalt

Research output: Contribution to journalArticle

Abstract

The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.

Original languageEnglish
Pages (from-to)1199-1204
Number of pages6
JournalPediatric Nephrology
Volume24
Issue number6
DOIs
Publication statusPublished - 2009

Keywords

  • Children
  • DMSA scan
  • Procalcitonin
  • Renal scar
  • Urinary tract infection

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

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