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Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging

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Abstract

Background

We examined the ability of a procalcitonin (PCT) protocol to detect vesicoureteral reflux (VUR) and renal scarring (RS), evaluated procedural costs and radiation burden, and compared four representative guidelines for children with their first febrile urinary tract infection (UTI).

Methods

Children aged ≤2 years with their first febrile UTI who underwent renal ultrasonography (US), acute and late technetium-99m (99mTc)-dimercaptosuccinic acid scan, and voiding cystourethrography were prospectively studied. The representative guidelines applied in a retrospective simulation included the American Academy of Pediatrics (AAP), National Institute of Clinical Excellence, top-down approach (TDA), and Italian Society of Pediatric Nephrology (ISPN). These were compared in terms of ability to detect abnormalities, procedural costs and radiation.

Results

Of 278 children analyzed, 172 (61.9 %) had acute pyelonephritis. There was VUR in 101 (36.3 %) children, including 73 (26.3 %) with grades III–V VUR. RS was identified in 75 (27.0 %) children. To detect VUR, TDA and PCT had the highest sensitivity for grades I–V VUR (80.2 %) and III–V VUR (94.5 %), respectively, whereas AAP had the highest specificity for I–V VUR (77.4 %) and III–V VUR (78.0 %), respectively. TDA and PCT had the highest sensitivity (100 %) for detecting RS. The highest cost and radiation dose was associated with TDA, whereas AAP had the least expenditure and radiation exposure. By multivariate analysis, PCT and VUR, especially grades III–V, were independent predictors of RS.

Conclusions

There is no perfect guideline for first febrile UTI children. The PCT protocol has good ability for detecting high-grade VUR and RS. If based on available imaging modalities and reducing cost and radiation burden, clinical suggestions in the AAP guidelines represent a considerable protocol.

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Acknowledgments

This study was supported by grants from the National Science Council, Taiwan (NSC93-2314-B-040-012) and the Chung Shan Medical University Hospital, Taiwan (CSH-2012-C-010).

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Authors and Affiliations

  1. Department of Pediatrics, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung, 402, Taiwan

    Pei-Fen Liao, Min-Sho Ku, Jeng-Dau Tsai, Yu-Hua Choa, Ko-Huang Lue & Ji-Nan Sheu

  2. Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

    Tung-Wei Hung

  3. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Jeng-Dau Tsai, Yu-Hua Choa & Tung-Wei Hung

  4. School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Min-Sho Ku, Ko-Huang Lue & Ji-Nan Sheu

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  1. Pei-Fen Liao
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Correspondence to Ji-Nan Sheu.

Additional information

Pei-Fen Liao and Min-Sho Ku contributed equally to this work.

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Liao, PF., Ku, MS., Tsai, JD. et al. Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging. Pediatr Nephrol 29, 1567–1574 (2014). https://doi.org/10.1007/s00467-014-2801-z

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  • DOI: https://doi.org/10.1007/s00467-014-2801-z

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