Gkiourtzis Nikolaos, Stoimeni Anastasia, Michou Panagiota, Charitakis Nikolaos, Cheirakis Konstantinos, Liakos Vasileios, Makedou Kali, Printza Nikoleta, Antachopoulos Charalampos, Tramma Despoina
4th Department of Pediatrics, School of Medicine, Department of Health Sciences, "G. Papageorgiou" General Hospital, Aristotle University of Thessaloniki, 54124 & Ring Road Municipality of Pavlou Mela Area N. Evkarpia, 56403, Thessaloniki, Greece.
Pediatric Department, G. Gennimatas General Hospital, Thessaloniki, Greece.
Pediatr Nephrol. 2025 Jul 31. doi: 10.1007/s00467-025-06885-0.
Children with febrile urinary tract infections (fUTI), especially those with acute pyelonephritis (APN) and vesicoureteral reflux (VUR), may face several complications, especially kidney scarring. Different biomarkers, such as urinary neutrophil gelatinase-associated lipocalin (uNGAL) and procalcitonin (PCT), have been studied for predicting kidney scarring without the need for a DMSA scan.
This systematic review and meta-analysis examines the role of biomarkers in pediatric patients with a history of fUTI and their prognostic value in the diagnosis of APN and prediction of kidney scarring.
A search through major databases (MEDLINE/PubMed and Scopus) was conducted from inception until January 2, 2025. The mean difference (95% CI) was applied. A p < 0.05 was considered statistically significant.
The systematic review included 2300 participants from 28 studies. Procalcitonin and uNGAL were higher in individuals with scarring after a fUTI episode compared to those without scarring (p = 0.035 and p < 0.0001, respectively). In addition, PCT was higher in patients with APN compared to those with lower UTI (p < 0.0001). Finally, the good and moderate overall diagnostic accuracy (I = 29.8%) of PCT in predicting APN (AUC: 0.861) and uNGAL (I = 16.8%) in predicting kidney scarring after an episode of fUTI (AUC: 0.74), respectively, should be considered.
This study showed that PCT and uNGAL can detect APN and kidney scarring after fUTI. More studies should be conducted exploring the role of other biomarkers in scarring after an episode of fUTI in pediatric patients with or without VUR.
发热性尿路感染（fUTI）患儿，尤其是患有急性肾盂肾炎（APN）和膀胱输尿管反流（VUR）的患儿，可能面临多种并发症，尤其是肾瘢痕形成。已经对不同的生物标志物，如尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和降钙素原（PCT）进行了研究，以在无需进行二巯基丁二酸（DMSA）扫描的情况下预测肾瘢痕形成。
本系统评价和荟萃分析探讨了生物标志物在有fUTI病史的儿科患者中的作用及其在APN诊断和肾瘢痕形成预测中的预后价值。
从数据库创建至2025年1月2日，通过主要数据库（MEDLINE/PubMed和Scopus）进行检索。应用平均差（95%可信区间）。p < 0.05被认为具有统计学意义。
该系统评价纳入了来自28项研究的2300名参与者。与无瘢痕形成的个体相比，fUTI发作后有瘢痕形成的个体中降钙素原和uNGAL更高（分别为p = 0.035和p < 0.0001）。此外，与下尿路感染患者相比，APN患者的PCT更高（p < 0.0001）。最后，应考虑PCT在预测APN方面的良好和中等总体诊断准确性（I = 29.8%）（AUC：0.861）以及uNGAL在预测fUTI发作后肾瘢痕形成方面的诊断准确性（I = 16.8%）（AUC：0.74）。
本研究表明，PCT和uNGAL可以检测fUTI后的APN和肾瘢痕形成。应开展更多研究，探索其他生物标志物在有或无VUR的儿科患者fUTI发作后瘢痕形成中的作用。
