Clinical Usefulness of Serum Procalcitonin as a Biomarker of Acute Pyelonephritis

Korean Journal of Nephrology 2010;29(6):716-724.

Eun Ae Yang, M.D.1, Jun Seok Park, M.D.1, Min Hyun Cho, M.D.1 and Sang-Woo Lee, M.D.2

Department of Pediatrics1 and Nuclear Medicine²
Kyungpook National University School of Medicine, Daegu, Korea

원저 : 급성 신우신염의 표지자로서 혈청 procalcitonin의 임상적 유용성

양은애1, 박준석1, 조민현1, 이상우2

경북대학교 의학전문대학원 소아과학교실1, 핵의학교실2

Abstract

Purpose: The clinical usefulness of serum procalcitonin (PCT) was evaluated for the diagnosis of acute pyelonephritis (APN) in infants with urinary tract infections (UTIs). Methods: A total of 46 infants (between 1 and 12 months of age) were enrolled in this study. Laboratory studies including the WBC count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and PCT were measured before initiation of intravenous antibiotic treatment and a 99mTc-DMSA renal scan was performed during treatment. Results: There were no significant differences in the mean age, gender and microorganisms detected between the patients with a lower UTI and those with APN. The duration of fever before and after treatment was significantly longer in the APN group. Except for the WBC count, there was a significantly higher ESR, serum CRP and PCT levels detected in the APN group. Although the serum CRP and PCT showed similar sensitivity and specificity for the diagnosis of APN, simultaneous measurement of the ESR, serum CRP and PCT increased the specificity and accuracy for the diagnosis of APN. Furthermore, only the serum PCT showed a statistically significant difference between the groups with no or only a very mild renal lesion (group 1) and the groups with significant renal lesions (group 2). Conclusion: The serum PCT combined with the ESR and serum CRP was a helpful marker for the diagnosis of APN. In addition, the serum PCT could be a useful predictor of the severity of renal parenchymal involvement associated with APN.

Key Words: Pyelonephritis, Procalcitonin, Urinary tract infection