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. 2019;44(2):174-180.
doi: 10.5114/ceji.2019.87069. Epub 2019 Jul 30.

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
Affiliations

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 et al. Cent Eur J Immunol. 2019.

Abstract

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

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Levels of uNGAL, uNGAL normalized to uCr (uNGAL/uCr), uKIM-1 and uKIM-1 normalized to uCr (uKIM-1/uCr) in infants with acute pyelonephritis (APN) and lower urinary tract infection (UTI)
Fig. 2
Fig. 2
Receiver operating curve to predict acute pyelonephritis (APN) for procalcitonin (PCT) and C-reactive protein (CRP)
See this image and copyright information in PMC

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