Leroy S, Gervaix A
Unité d'épidémiologie des maladies émergentes, Institut Pasteur, Paris, France.
Arch Pediatr. 2013 Jan;20(1):54-62. doi: 10.1016/j.arcped.2012.10.025. Epub 2012 Nov 27.
Urinary tract infections (UTIs) are one of the most common sources of bacterial infections among young febrile children. Accurate diagnosis of acute pyelonephritis (APN) and vesico-ureteral reflux (VUR) are important because of their association with renal scarring, sometimes leading to long-term complications. However, the gold standard examinations are either a DMSA scan for APN and scarring, or cystography for VUR, but both present limitations (feasibility, pain, cost, etc.). Procalcitonin, a reliable marker of bacterial infections, was demonstrated to be a good predictor of renal parenchymal involvement in the acute phase and in late renal scars, as well as of high-grade VUR. These findings need further broad validations and impact studies before being implemented into daily practice. However, procalcitonin may play a role in the complex and still debated picture of which examination should be performed after UTI in children.
尿路感染（UTIs）是发热儿童中最常见的细菌感染源之一。准确诊断急性肾盂肾炎（APN）和膀胱输尿管反流（VUR）很重要，因为它们与肾瘢痕形成有关，有时会导致长期并发症。然而，金标准检查要么是用于APN和瘢痕形成的二巯基丁二酸（DMSA）扫描，要么是用于VUR的膀胱造影，但两者都存在局限性（可行性、疼痛、成本等）。降钙素原是细菌感染的可靠标志物，已被证明是急性期和晚期肾瘢痕中肾实质受累以及重度VUR的良好预测指标。在将这些发现应用于日常实践之前，需要进一步广泛的验证和影响研究。然而，降钙素原可能在儿童UTI后应进行何种检查这一复杂且仍有争议的情况中发挥作用。
