The diagnosis of febrile urinary tract infection in children may be facilitated by urinary biomarkers
The diagnosis of febrile urinary tract infection in children may be facilitated by urinary biomarkers
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DOI：
10.1007/s00467-014-2905-5
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发表时间：
2015-01-01
影响因子：
3
通讯作者：
Park, Kwanjin
中科院分区：
文献类型：
--
作者：
Lee, Hahn-Ey;Kim, Do Kyun;Park, Kwanjin
我们前瞻性地评估了两种肾损伤的尿液标志物作为急性发热性尿路感染（UTI）和随后的肾瘢痕形成的潜在诊断试验的可行性。患者队列包括0至4岁的急诊室就诊的儿童。儿童被分为三组，即发热UTI（fUTI），发热对照组（FC）和非发热对照组（NFC），分别为性别和年龄相匹配。对从每个孩子身上收集的尿液进行了中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤分子-1（KIM-1）的酶联免疫吸附测定。比较三组之间两种标志物的尿液水平，并根据受试者-操作者特征曲线下面积（AUC）确定诊断准确性。在fUTI组中，通过将尿水平与UTI发作后6个月的二巯基琥珀酸结果相关联来评估随后的肾瘢痕形成的可预测性，在fUTI组中观察到尿NGAL和KIM-1水平显著升高，以及尿酯酶、血清C反应蛋白和脓尿增加。KIM-1的AUC为72%，NGAL为96%。用于预测瘢痕形成的KIM-1的AUC为71%（p < 0.05）。发热性UTI的诊断和随后的瘢痕形成的预测可以通过以可接受的准确度测定尿生物标志物来促进。
We prospectively assessed the feasibility of two urinary markers of renal injury as potential diagnostic tests for acute febrile urinary tract infection (UTI) and subsequent renal scarring.The patient cohort comprised children aged 0 to 4 years who visited the emergency room. The children were divided into three groups, namely, a febrile UTI (fUTI), febrile control (FC) and a non-febrile control (NFC) group, respectively, which were matched for sex and age. An enzyme-linked immunosorbent assay for neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) was performed on urine collected from each child. The urine levels of both markers were compared between the three groups, and the diagnostic accuracy was determined based on the area under the receiver-operator characteristic curve (AUC). In the fUTI group, the predictability of subsequent renal scarring was assessed by associating urinary levels with dimercaptosuccinic acid findings 6 months after an UTI episode.Significantly elevated levels of urinary NGAL and KIM-1 were observed in the fUTI group, as well as with increased urine esterase, serum C-reactive protein, and pyuria. The AUC was 72 % for KIM-1 and 96 % for NGAL. The AUC of KIM-1 for the prediction of scarring was 71 % (p < 0.05).The diagnosis of febrile UTI and the prediction of subsequent scarring may be facilitated by assaying urine biomarkers with acceptable accuracy.