Baranton Emma, Ribet Chloé, Freyssinet Emma, Bernardor Julie, Boyer Corinne, Lavrut-Hollecker Florence, Demonchy Diane, Schuler Emma, Fontas Eric, Tran Antoine
Pediatric Emergency Department, Lenval Children's Hospital, 06200 Nice, France.
Pediatric Nephrology Department, University Hospital of Nice Archet 2, 06200 Nice, France.
Children (Basel). 2024 Sep 3;11(9):1081. doi: 10.3390/children11091081.
Urinary tract infections (UTIs) are very common bacterial infections in children. Early detection of renal parenchymal involvement in this setting can help clinicians make more effective treatment choices. The aim of this pilot study was to assess the ability of plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) levels, measured using an automated system, to accurately predict renal parenchymal involvement in children with febrile UTIs.
This prospective single-center study included 28 children aged ≥ 4 years with a first episode of febrile UTIs. All patients underwent magnetic resonance imaging. pNGAL, uNGAL, procalcitonin, C-reactive protein (CRP), and white blood cells were measured before antibiotic therapy.
The receiver operating characteristic (ROC) area under the curve for predicting acute pyelonephritis was 0.6 for pNGAL, 0.8 for CRP, 0.4 for PCT, and 0.4 for uNGAL. The ROC analyses showed an optimal cutoff of 141.0 ng/mL for pNGAL (sensitivity, 54.2%; specificity, 75.0%; positive predictive value, 92.9%; and negative predictive value, 21.4%).
pNGAL and uNGAL did not effectively aid the early prediction of renal parenchymal involvement in children ≥ 4 years with febrile UTIs. The novelties of this study were the use of MRI as the gold standard and an automated biochemical method to measure NGAL.
尿路感染（UTIs）是儿童中非常常见的细菌感染。在此情况下早期检测肾实质受累情况有助于临床医生做出更有效的治疗选择。这项初步研究的目的是评估使用自动化系统测量的血浆和尿液中性粒细胞明胶酶相关脂质运载蛋白（pNGAL和uNGAL）水平准确预测发热性UTIs儿童肾实质受累情况的能力。
这项前瞻性单中心研究纳入了28名年龄≥4岁的首次发生发热性UTIs的儿童。所有患者均接受了磁共振成像检查。在抗生素治疗前测量pNGAL、uNGAL、降钙素原、C反应蛋白（CRP）和白细胞。
预测急性肾盂肾炎的受试者工作特征（ROC）曲线下面积，pNGAL为0.6，CRP为0.8，PCT为0.4，uNGAL为0.4。ROC分析显示pNGAL的最佳截断值为141.0 ng/mL（敏感性为54.2%；特异性为75.0%；阳性预测值为92.9%；阴性预测值为21.4%）。
pNGAL和uNGAL不能有效辅助早期预测≥4岁发热性UTIs儿童的肾实质受累情况。本研究的新颖之处在于使用MRI作为金标准以及采用自动化生化方法测量NGAL。
