Nader Shaikh1, Judith M Martin2, Alejandro Hoberman2, Megan Skae3, Linette Milkovich3, Andrew Nowalk2, Christi McElheny4, Robert W Hickey2, Diana Kearney3, Massoud Majd5, Eglal Shalaby-Rana5, George Tseng6, John F Alcorn3, Jay Kolls7, Marcia Kurs-Lasky8, Zhiguang Huo9, William Horne3, Greg Lockhart10, Hans Pohl5, Timothy R Shope2. 1. Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA. Electronic address: nader.shaikh@chp.edu. 2. Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA. 3. Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA. 4. Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 5. Children's National Medical Center, Washington, DC. 6. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 7. Tulane School of Medicine, New Orleans, LA. 8. Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA. 9. Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL. 10. Hasbro Children's Hospital, Alpert Medical School, Providence, RI.
Abstract
OBJECTIVE: To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. STUDY DESIGN: We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. RESULTS: Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. CONCLUSIONS: Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
OBJECTIVE: To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. STUDY DESIGN: We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. RESULTS: Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. CONCLUSIONS: Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
Authors: Adam F M Stone; Michael A Mendall; Juan-Carlos Kaski; Tracey M Edger; Paul Risley; Jan Poloniecki; A John Camm; Timothy C Northfield Journal: Circulation Date: 2002-09-03 Impact factor: 29.690
Authors: B A Jantausch; B L Wiedermann; S I Hull; B Nowicki; P R Getson; H G Rushton; M Majd; N L Luban; W J Rodriguez Journal: Pediatr Infect Dis J Date: 1992-05 Impact factor: 2.129