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Urinary carbohydrate antigen 19-9 level as a biomarker in children with acute pyelonephritis

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Abstract

Early and prompt diagnosis of pyelonephritis is of great importance in children. The aim of this study is to evaluate the diagnostic accuracy of urinary carbohydrate antigen 19-9 (CA19-9) levels for predicting acute pyelonephritis (APN) in children with urinary tract infection (UTI). Patients were allocated into two groups of APN and acute cystitis according to their diagnosis. Urine samples of all patients were collected. Also, complete history was taken, and physical examination, kidney and bladder ultrasonography, 99mTc-dimercaptosuccinic acid renal cortical scintigraphy, and urine analysis and culture were performed. Urinary CA19-9 was measured by an electrochemiluminescence enzyme immunometric kit. In addition, CA19-9 levels were measured in the APN group 2 weeks and 3 months later. A total of 100 children were included in this study (mean age 46 ± 31 months, 16 males and 84 females). CA19-9 levels were significantly greater in the APN group than acute cystitis group (510 ± 328 vs. 18.7 ± 18.6 U/ml, P < 0.001). During follow-up periods of the APN group, CA19-9 levels decreased to 180 ± 124 U/ml after 2 weeks (P < 0.001) and 30 ± 23 U/ml after 3 months (P < 0.001). Urinary CA-19-9 had 95.3% sensitivity and 80% specificity for the diagnosis of APN. The area under the curve value of CA19-9 was 0.904 (95% CI 0.831–0.977).

Conclusion: Urinary CA19-9 level can be used as a reliable biomarker for early detection of APN prior to urine culture confirmation in children with UTI.

What is known:

• Early and prompt diagnosis of pyelonephritis is necessary in children to prevent renal damage.

• Acute pyelonephritis can present with vague and nonspecific symptoms in infants and children.

What is new:

• Urinary carbohydrate antigen 19-9 is a reliable biomarker for early detection of acute pyelonephritis prior to urine culture confirmation.

• Urinary carbohydrate antigen 19-9 has 95.3% sensitivity and 80% specificity for diagnosis of acute pyelonephritis.

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Abbreviations

APN:

Acute pyelonephritis

CA19-9:

Carbohydrate antigen 19-9

CRP:

C-reactive protein

DMSA:

99mTc-dimercaptosuccinic acid

DNI:

Delta neutrophil index

ESR:

Erythrocyte sedimentation rate

NGAL:

Neutrophil gelatinase-associated lipocalin

PCT:

Procalcitonin

ROC:

Receiver operating characteristic

US:

Ultrasonography

UTI:

Urinary tract infection

VCUG:

Voiding cystourethrography

WBC:

White blood cell

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Authors and Affiliations

  1. Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib’s St, Keshavarz Blvd, Tehran, 14194 33151, Iran

    Abdol-Mohammad Kajbafzadeh, Seyedeh Sanam Ladi Seyedian, Seyedeh Maryam Kameli & Behnam Nabavizadeh

  2. Pediatric Nephrology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Maryam Boroomand & Mastaneh Moghtaderi

Authors
  1. Abdol-Mohammad Kajbafzadeh
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Contributions

Abdol-Mohammad Kajbafzadeh: study conception and design, study coordination, critical revision

Seyedeh-Sanam Ladi-Seyedian: study design, data collection, analysis and interpretation of data, writing the manuscript

Seyedeh Maryam Kameli: data collection, revision of the manuscript

Behnam Nabavizadeh: writing the manuscript

Maryam Boroomand: data collection, revision of the manuscript

Mastaneh Moghtaderi: data collection, revision of the manuscript

Corresponding author

Correspondence to Abdol-Mohammad Kajbafzadeh.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants/parents included in the study.

Additional information

Communicated by Mario Bianchetti

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Kajbafzadeh, AM., Ladi Seyedian, S.S., Kameli, S.M. et al. Urinary carbohydrate antigen 19-9 level as a biomarker in children with acute pyelonephritis. Eur J Pediatr 179, 1389–1394 (2020). https://doi.org/10.1007/s00431-020-03626-3

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  • DOI: https://doi.org/10.1007/s00431-020-03626-3

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