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J Pediatr. 2019 Mar 21. pii: S0022-3476(19)30027-7. doi: 10.1016/j.jpeds.2019.01.012. [Epub ahead of print]

Host and Bacterial Markers that Differ in Children with Cystitis and Pyelonephritis.

Author information

1
Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA. Electronic address: nader.shaikh@chp.edu.
2
Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA.
3
Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA.
4
Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
5
Children's National Medical Center, Washington, DC.
6
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
7
Tulane School of Medicine, New Orleans, LA.
8
Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA.
9
Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL.
10
Hasbro Children's Hospital, Alpert Medical School, Providence, RI.

Abstract

OBJECTIVE:

To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis.

STUDY DESIGN:

We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes.

RESULTS:

Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis.

CONCLUSIONS:

Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.

KEYWORDS:

UTI; calculator; diagnostic accuracy; prediction rule; risk

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