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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.




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.




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.




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.