Procalcitonin in predicting acute kidney damage in children with initial febrile urinary tract infection: a retrospective study.

BACKGROUND

Urinary tract infection (UTI) is the most common bacterial infection in children, with 10-15% progressing to irreversible renal scarring. This study evaluated the predictive value of inflammatory markers for acute renal damage in children with first febrile UTI.

METHODS

This study conducted a retrospective analysis of 143 children with initial febrile UTI who underwent technetium-99m labelled dimercaptosuccinic acid (99mTc-DMSA) scintigraphy for kidney damage assessment and had serum C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count, neutrophil percentage (NEUT%), and procalcitonin (PCT) measured. The efficiency of above inflammatory markers in predicting acute kidney damage was calculated and compared.

RESULTS

Univariate regression analysis revealed significant associations between acute kidney damage and CRP, absolute neutrophil count, and PCT. Multivariate regression identified both CRP [odds ratio (OR) 1.013, 95% confidence interval (CI): 1.003-1.024, P=0.02] and PCT (OR 1.671, 95% CI: 1.066-2.621, P=0.03) as independent predictors, with area under the curve (AUC) values of 0.718 and 0.815, respectively. Notably, a PCT cutoff >0.26 ng/mL demonstrated superior predictive value (sensitivity 87.1%, specificity 69.0%) compared to other markers.

CONCLUSIONS

Early measurement of inflammatory markers, particularly PCT, have significant predictive value for acute kidney damage in pediatric febrile UTI. While both PCT and CRP serve as reliable predictors, PCT demonstrates superior diagnostic accuracy, providing a new method to identify early kidney damage in children presenting with first febrile UTI for primary hospitals without single photon emission computer scanner or gamma camera.