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

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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.

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The authors state that they have no financial relationships with commercial companies pertaining to this topic.

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Authors and Affiliations

  1. Department of Pediatrics, University of Padua, Padua, Italy

    Silvia Bressan, Barbara Andreola, Giovanni Montini, Giorgio Perilongo & Liviana Da Dalt

  2. Nuclear Medicine Department, Azienda Ospedaliera–University of Padua, Padua, Italy

    Pietro Zucchetta & Marta Burei

  3. Dipartimento di Pediatria, Università di Padova, Via Giustiniani 3, 35128, Padova, Italy

    Liviana Da Dalt

Authors
  1. Silvia Bressan
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  2. Barbara Andreola
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  3. Pietro Zucchetta
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  4. Giovanni Montini
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  6. Giorgio Perilongo
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  7. Liviana Da Dalt
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Correspondence to Liviana Da Dalt.

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Bressan, S., Andreola, B., Zucchetta, P. et al. Procalcitonin as a predictor of renal scarring in infants and young children. Pediatr Nephrol 24, 1199–1204 (2009). https://doi.org/10.1007/s00467-009-1125-x

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  • DOI: https://doi.org/10.1007/s00467-009-1125-x

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