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Volume 40, Number 6, December 2007

Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children


Daniel Tsung-Ning Huang, Fu-Yuan Huang, Tsuen-Chiuan Tsai, Jeng-Daw Tsai, Nan-Chang Chiu, Chun-Chen Lin
Department of Pediatrics, Mackay Memorial Hospital, Taipei; and 2Department of Pediatrics, Taipei Medical University Municipal Wan-Fang Hospital, Taipei, Taiwan

Received: May 31, 2006    Revised: July 20, 2006    Accepted: August 10, 2006   

 

Corresponding author:

Dr. Tsuen-Chiuan Tsai, Department of Pediatrics, Taipei Medical University Municipal Wan-Fang Hospital, No. 111, Sec. 3, Hsing-Long Road, Taipei 116, Taiwan. E-mail: Dr. Tsuen-Chiuan Tsai This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

To evaluate clinical variables for diagnosing childhood acute pyelonephritis (APN) when technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy is not available.

 



 

Methods:

We retrospectively reviewed the records of 590 children with febrile UTI seen from January 1999 to February 2004. On the basis of DMSA scintigraphy performed within 7 days after admission, they were divided into APN (n = 237) or non-APN (n = 353) groups. Gender, age, clinical presentation, absolute neutrophil count, C-reactive protein (CRP), urinalysis, culture, and sonographic findings were recorded from charts.

 



 

Results:

A CRP level of ≥66.4 mg/L, in patients with >2 days prior to admission had a sensitivity of 71.6% and a specificity of 72.5% for APN. Similarly, a CRP of >27.3 mg/L in patients with ≤2 days prior to admission and a white cell count of >14,990/mm3 had sensitivities of 68.6% and 62.0% and specificities of 66.1% and 63.0%, respectively. Combining two or more variables did not result in better discrimination.

 



 

Conclusion:

The PCR method could provide earlier diagnosis of M. pneumoniae infection and was useful to identify variable clinical features of infection, especially in younger children.

 



 

Key words:

C-reactive protein; Diagnosis, differential; Pyelonephritis; Technetium Tc 99m dimercaptosuccinic acid; Urinary tract infections


 



 

J Microbiol Immunol Infect. 2007;40:513-517.