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Urine specific gravity, pyuria, and neutrophil gelatinase-associated lipocalin for identifying urinary tract infection in young children

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A Letter to the Editors to this article was published on 13 October 2023

Abstract

Background

To determine whether urine neutrophil gelatinase-associated lipocalin (uNGAL) might be superior to pyuria for detecting urinary tract infection (UTI) regardless of urine specific gravity (SG) in young children.

Methods

We conducted a retrospective analysis of children aged < 3 years who were evaluated for UTI with urinalysis, urine culture, and uNGAL measurements during a 5-year period. Sensitivity, specificity, likelihood ratios (LRs), predictive values (PVs), area under the curves (AUCs) of uNGAL cut-off levels, and various microscopic pyuria thresholds for detecting UTI were calculated for dilute (SG < 1.015) and concentrated urine (SG ≥ 1.015).

Results

Of 456 children included, 218 had UTI. The diagnostic value of urine white blood cell (WBC) concentration to define UTI changed with urine SG. For detecting UTI, uNGAL cut-off of 68.4 ng/mL had higher AUC values than pyuria ≥ 5 WBCs/high power field (HPF) for dilute and concentrated urine samples (both P < 0.05). Positive LR and PV and specificity of uNGAL were all greater than those of pyuria ≥ 5 WBCs/HPF regardless of urine SG, although the sensitivity of pyuria ≥ 5 WBCs/HPF was higher than that of uNGAL cut-off for dilute urine (93.8% vs. 83.5%) (P < 0.05). At uNGAL ≥ 68.4 ng/mL and ≥ 5 WBCs/HPF, posttest probabilities of UTI were 68.8% and 57.5% for dilute urine and 73.4% and 57.3% for concentrated urine, respectively.

Conclusions

Urine SG can affect the diagnostic performance of pyuria for detecting UTI and uNGAL might be helpful for identifying UTI regardless of urine SG in young children.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgments

This work was supported by a Korea University Grant (No. K1912741). We also would like to express our gratitude to Professor Hang Seok Choi (Medical Science Research Center, Korea University College of Medicine) for statistical advice.

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Authors and Affiliations

  1. Department of Pediatrics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea

    Do Young Kim, Hyung Eun Yim & Min Hwa Son

  2. Department of Pediatrics, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Kee Hwan Yoo

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Contributions

Dr. Hyung Eun Yim contributed to the study conception, study design, and project administration. Material preparation and data collection were performed by Do Young Kim, Hyung Eun Yim, and Kee Hwan Yoo. Statistical analyses were performed by Do Young Kim. Visualization was produced by Do Young Kim and Min Hwa Son. The first draft of the manuscript was written by Do Young Kim. It was reviewed and revised by Do Young Kim, Hyung Eun Yim, Min Hwa Son, and Kee Hwan Yoo. All authors read and approved the final manuscript.

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Correspondence to Hyung Eun Yim.

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Authors have no financial interests that are directly or indirectly related to the work submitted here for publication.

Ethics statement

This study was approved by our Institutional Review Board (IRB) before initiation (Korea University Guro Hospital, IRB number: 2018GR0321). The IRB waived the requirement to obtain informed consent since this study involved a retrospective chart review of anonymous patient data. This study was carried out in accordance with the Declaration of Helsinki. Patients' data from our previous papers [23, 31] were partially included.

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Kim, D.Y., Yim, H.E., Son, M.H. et al. Urine specific gravity, pyuria, and neutrophil gelatinase-associated lipocalin for identifying urinary tract infection in young children. Pediatr Nephrol 38, 3337–3346 (2023). https://doi.org/10.1007/s00467-023-05957-3

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