Abstract
Background
The sensitivity and specificity of the leukocyte esterase test are relatively low for a screening test for urinary tract infection (UTI). More accurate tests could reduce both overtreatment and missed cases. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) can replace leukocyte esterase in the diagnosis of UTI and/or whether NGAL accurately identifies children with acute pyelonephritis.
Methods
Data sources—MEDLINE and EMBASE. We only considered published studies that evaluated the results of an index test (NGAL) against the results of urine culture (for UTI) or against the results of dimercaptosuccinic acid (for acute pyelonephritis) in children aged 0 to 18 years. Two authors independently applied the selection criteria to all citations and independently extracted the data.
Results
A total of 12 studies met our inclusion criteria. Four studies (920 children) included data on NGAL for UTI; eight studies (580 children) included data on NGAL for pyelonephritis. We did not pool accuracy values because the included studies used different cutoff values. For the diagnosis of UTI, urinary NGAL appeared to have better accuracy than the leukocyte esterase test in all included studies. For the diagnosis of pyelonephritis, neither plasma NGAL nor urinary NGAL had high sensitivity and/or specificity. The number of studies was the main limitation of this systematic review.
Conclusions
Urinary NGAL appears promising for the diagnosis of UTI; however, larger studies are needed to validate this marker as a replacement for leukocyte esterase. The use of NGAL for diagnosing acute pyelonephritis requires further study.
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Abbreviations
- UTI:
-
Urinary tract infection
- NGAL:
-
Neutrophil gelatinase-associated lipocalin
- pNGAL:
-
Plasma neutrophil gelatinase-associated lipocalin
- uNGAL:
-
Urine neutrophil gelatinase-associated lipocalin
- APN:
-
Acute pyelonephritis
- PCT:
-
Procalcitonin
- CRP:
-
C-reactive protein
- DMSA:
-
Dimercaptosuccinic acid
- WBC:
-
White blood cell
- CFU:
-
Colony-forming unit
- QUADAS:
-
Quality Assessment of Diagnostic Accuracy Studies
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Dr. Nader Shaikh is responsible for the study concept and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, and statistical analysis. He had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Kai Shaikh, Victor Osio, and Vinod Rajakumar are responsible for the acquisition of data, analysis and interpretation of data, and drafting of the manuscript.
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Shaikh, K., Rajakumar, V., Osio, V.A. et al. Neutrophil gelatinase-associated lipocalin for urinary tract infection and pyelonephritis: a systematic review. Pediatr Nephrol 36, 1481–1487 (2021). https://doi.org/10.1007/s00467-020-04854-3
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DOI: https://doi.org/10.1007/s00467-020-04854-3