eISSN: 1644-4124
ISSN: 1426-3912
Central European Journal of Immunology
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2/2019
vol. 44
 
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abstract:
Clinical immunology

Diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin and urine kidney injury molecule-1 as predictors of acute pyelonephritis in young children with febrile urinary tract infection

Grażyna Krzemień
1
,
Małgorzata Pańczyk-Tomaszewska
1
,
Iwona Kotuła
2
,
Urszula Demkow
2
,
Agnieszka Szmigielska
1

  1. Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
  2. Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Poland
(Centr Eur J Immunol 2019; 44 (2): 174-180)
DOI: https://doi.org/10.5114/ceji.2019.87069
Online publish date: 2019/07/30
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Introduction
We assessed whether two urinary biomarkers of acute kidney injury, neutrophil gelatinase associated lipocalin (uNGAL) and kidney injury molecule-1 (uKIM-1), can be useful for predicting acute pyelonephritis (APN) in children aged 1-24 months with the first febrile urinary tract infection (UTI).

Material and methods
A prospective study included 54 children divided into two groups (24 with APN, 30 with lower UTI), according to the dimercaptosuccinic acid (DMSA) renal scintigraphy results. Laboratory tests: uNGAL, uKIM-1, procalcitonin (PCT), C-reactive protein (CRP), white blood count (WBC) were performed.

Results
We did not find significant differences in normalized and non-normalized values of uNGAL and uKIM-1 in children with APN and lower UTI. Positive correlations were determined between uNGAL and pyuria (r = 0.28, p < 0.05) and between uNGAL/uCr and uKIM-1/uCr (r = 0.53, p < 0.001) in the all UTI groups. Univariate logistic regression analysis demonstrated that only PCT (p < 0.0001) and CRP (p < 0.05) were important diagnostic factors of APN. Receiver operating curve (ROC) analysis showed good diagnostic profiles of PCT with the best cut-off value of 1.66 ng/ml and of CRP with the best cut-off value of 4.3 mg/dl for predicting APN (area under the curve [AUC]: 0.894 and 0.719, sensitivity: 75% and 96%, specificity: 93% and 43%, respectively).

Conclusions
uNGAL and uKIM-1 are not effective diagnostic markers for APN in young children with febrile UTI and cannot be used in clinical practice to differentiate APN from lower UTI.

keywords:

acute pyelonephritis, urinary tract infection, acute kidney injury, biomarkers, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, dimercaptosuccinic acid scintigraphy, children
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