Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
Pediatric Nephrology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Pediatr. 2020 Sep;179(9):1389-1394. doi: 10.1007/s00431-020-03626-3. Epub 2020 Mar 7.
Early and prompt diagnosis of pyelonephritis is of great importance in children. The aim of this study is to evaluate the diagnostic accuracy of urinary carbohydrate antigen 19-9 (CA19-9) levels for predicting acute pyelonephritis (APN) in children with urinary tract infection (UTI). Patients were allocated into two groups of APN and acute cystitis according to their diagnosis. Urine samples of all patients were collected. Also, complete history was taken, and physical examination, kidney and bladder ultrasonography, Tc-dimercaptosuccinic acid renal cortical scintigraphy, and urine analysis and culture were performed. Urinary CA19-9 was measured by an electrochemiluminescence enzyme immunometric kit. In addition, CA19-9 levels were measured in the APN group 2 weeks and 3 months later. A total of 100 children were included in this study (mean age 46 ± 31 months, 16 males and 84 females). CA19-9 levels were significantly greater in the APN group than acute cystitis group (510 ± 328 vs. 18.7 ± 18.6 U/ml, P < 0.001). During follow-up periods of the APN group, CA19-9 levels decreased to 180 ± 124 U/ml after 2 weeks (P < 0.001) and 30 ± 23 U/ml after 3 months (P < 0.001). Urinary CA-19-9 had 95.3% sensitivity and 80% specificity for the diagnosis of APN. The area under the curve value of CA19-9 was 0.904 (95% CI 0.831-0.977).Conclusion: Urinary CA19-9 level can be used as a reliable biomarker for early detection of APN prior to urine culture confirmation in children with UTI. What is known: • Early and prompt diagnosis of pyelonephritis is necessary in children to prevent renal damage. • Acute pyelonephritis can present with vague and nonspecific symptoms in infants and children. What is new: • Urinary carbohydrate antigen 19-9 is a reliable biomarker for early detection of acute pyelonephritis prior to urine culture confirmation. • Urinary carbohydrate antigen 19-9 has 95.3% sensitivity and 80% specificity for diagnosis of acute pyelonephritis.
儿童肾盂肾炎的早期和及时诊断具有重要意义。本研究旨在评估尿碳水化合物抗原 19-9（CA19-9）水平对预测儿童尿路感染（UTI）中急性肾盂肾炎（APN）的诊断准确性。根据诊断结果，将患者分为急性肾盂肾炎和急性膀胱炎两组。收集所有患者的尿液样本。此外，还进行了完整的病史采集、体格检查、肾脏和膀胱超声检查、Tc-二巯丁二酸皮质闪烁显像、尿液分析和培养。通过电化学发光酶免疫测定试剂盒测量尿 CA19-9。此外，在 APN 组中分别在 2 周和 3 个月后测量 CA19-9 水平。本研究共纳入 100 例患儿（平均年龄 46±31 个月，男 16 例，女 84 例）。APN 组 CA19-9 水平明显高于急性膀胱炎组（510±328 vs. 18.7±18.6 U/ml，P<0.001）。在 APN 组的随访期间，CA19-9 水平在 2 周后降至 180±124 U/ml（P<0.001），3 个月后降至 30±23 U/ml（P<0.001）。尿 CA-19-9 对 APN 的诊断具有 95.3%的灵敏度和 80%的特异性。CA19-9 的曲线下面积值为 0.904（95%CI 0.831-0.977）。结论：在 UTI 患儿中，在尿液培养确认之前，尿 CA19-9 水平可作为早期检测 APN 的可靠生物标志物。已知：• 儿童肾盂肾炎的早期和及时诊断对于预防肾损伤是必要的。• 急性肾盂肾炎在婴儿和儿童中可能表现出模糊和非特异性症状。新内容：• 尿碳水化合物抗原 19-9 是在尿液培养确认之前早期检测急性肾盂肾炎的可靠生物标志物。• 尿碳水化合物抗原 19-9 对急性肾盂肾炎的诊断具有 95.3%的灵敏度和 80%的特异性。
