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European Journal of Pediatrics

, Volume 174, Issue 1, pp 43–48 | Cite as

Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis

  • Kanita Lertdumrongluk
  • Thanunrat Thongmee
  • Stephen J. Kerr
  • Apiradee Theamboonlers
  • Yong Poovorawan
  • Pornpimol RianthavornEmail author
Original Article

Abstract

Timely antibiotic initiation for acute pyelonephritis (APN) can prevent renal complications. We investigated whether urine heparin binding protein (UHBP), a cytokine released from activated neutrophils, was a useful diagnostic tool for APN. Febrile children with presumed APN were prospectively enrolled between January and September 2013, and divided into two groups based on urine cultures. UHBP levels were measured at enrollment in all children and 1 month after antibiotic treatment in children with APN. UHBP levels in children with APN at baseline and 1 month versus controls were 47.0 ± 8.4 and 16.6 ± 3.8 vs. 15.0 ± 2.9 ng/mL, respectively (p < 0.001). Test performance characteristics were calculated against a gold standard of positive urine cultures and compared with leukocyte esterase (LE) and nitrite measured by dipsticks and pyuria by microscopy. The sensitivity and specificity for UHBP levels ≥34 ng/mL were 100 and 100 %. Spearman’s rank coefficient was used to assess the associations between routine laboratory tests and UHBP levels. Significant positive correlations were found with pyuria grade (Spearman’s rho = 0.62; p < 0.001), neutrophil count (rho = 0.38; p = 0.03), and platelet count (rho = 0.39; p = 0.03). Conclusions: UHBP is a valid adjunctive diagnostic tool for aiding clinicians in making rapid treatment decisions for APN.

Keywords

Acute pyelonephritis Sensitivity Specificity Urine heparin binding protein 

Abbreviations

APN

Acute pyelonephritis

AUC

Area under the receiver-operating characteristic curves

BUN

Blood urea nitrogen

CFU

Colony forming unit

GFR

Glomerular filtration rate

HBP

Heparin binding protein

HPF

High power field

IQR

Interquartile range

LE

Leucocyte esterase

NPV

Negative predictive value

PPV

Positive predictive value

ROC

Receiver-operating characteristic

UHBP

Urine heparin binding protein

UTI

Urinary tract infection

VUR

Vesicoureteral reflux

WBC

White blood cell

Notes

Acknowledgments

This work was supported by the Ratchadaphiseksomphot endowment fund, Faculty of Medicine, Chulalongkorn University (RA 2556-0012), the Higher Education Research Promotion and National Research University Project of Thailand, Office of the Higher Education Commission (HR1155A-55), Thailand Research Fund (DPG5480002), and the Center of Excellence in Clinical Virology, Chulalongkorn University, Integrated Innovation Academic Center IIAC Chulalongkorn University Centenary Academic Development Project (CU56-HR01).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

431_2014_2362_MOESM1_ESM.pdf (41 kb)
Online Resource 1 Completed checklists of standards for reporting of diagnostic accuracy (the STARD initiative) (PDF 40 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kanita Lertdumrongluk
    • 1
  • Thanunrat Thongmee
    • 2
  • Stephen J. Kerr
    • 3
    • 4
  • Apiradee Theamboonlers
    • 2
  • Yong Poovorawan
    • 2
  • Pornpimol Rianthavorn
    • 1
    Email author
  1. 1.Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityPathumwanThailand
  2. 2.Center of Excellence in Clinical Virology, Faculty of MedicineChulalongkorn UniversityPathumwanThailand
  3. 3.The HIV Nethrlands Australia Thailand Research Collaboration (HIV-NAT)PathumwanThailand
  4. 4.The Kirby Institute, UNSW AustraliaDarlinghurstAustralia

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