Skip to main content
SpringerLink
Log in

Do Serum C-reactive Protein and Interleukin-6 Predict Kidney Scarring After Urinary Tract Infection?

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To investigate if serum C-reactive protein (s-CRP) and interleukin 6 (s-IL6) provide information for predicting renal damage and for DMSA patient selection in children with urinary tract infection (UTI).

Methods

This observational study was carried out in children with UTI. s-CRP and s-IL6 were measured at UTI diagnosis. Patients forming renal scarring were identified by DMSA scans. The usefulness of s-CRP and s-IL6 measurements for nephropathy scarring diagnosis was evaluated using diagnostic quality and efficiency indexes.

Results

Thirty-two children were included in the study. Eight showed renal scarring after the follow-up. The s-CRP was 110.23 ± 59.69 mg/L and 52.46 ± 63.13 mg/L for patients with and without renal scarring. The s-IL6 concentration was 18.34 ± 11.80 pg/mL and 8.07 ± 9.51 pg/mL respectively. The cut-off points for optimum nephropathy scarring diagnosis were 115 mg/L for s-CRP and 20 pg/mL for s-IL6. The value of highest sensitivity for s-CRP was >5 mg/L (S:100 %) and greatest specificity was >150 mg/L (Sp:95.83). The highest sensitivity for s-IL6 was >4 pg/mL (S:100 %) and the maximum specificity was >40 pg/mL (Sp:100 %).

Conclusions

Results confirm that children who will develop renal scarring show higher levels of s-IL6 and s-CRP at UTI diagnosis. However, none of the techniques provide sufficient information for predicting renal damage in all patients and for DMSA patient selection

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Espinosa L. Infección urinaria. In: García Nieto V, Santos F, Rodríguez I, eds. Nefrología pediátrica. 2nd ed. Madrid: Aula Médica; 2006. pp. 507–20.

    Google Scholar 

  2. Rushton HG. Urinary tract infection in children. Epidemiology, evaluation and management. Pediatr Clin North Am. 1997;44:1133–69.

    Article  PubMed  CAS  Google Scholar 

  3. Navarro M, Espinosa L, Fernández C. Neuropatía cicatricial. In: García Nieto V, Santos F, Rodríguez I, eds. Nefrología pediátrica. 2nd ed. Madrid: Aula Médica; 2006. pp. 535–43.

    Google Scholar 

  4. National Institute for Health and Clinical Excellence (NICE). Urinary tract infection in children. (http://guidance.nice.org.uk/CG054). 2007.

  5. Coulthard MG, Lambert HJ, Keir MJ. Do systemic symptoms predict the risk of kidney scarring after urinary tract infection? Arch Dis Child. 2009;94:278–81.

    Article  PubMed  CAS  Google Scholar 

  6. Huang DT, Huang FY, Tsai TC, Tsai JD, Chiu NC, Lin CC. Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children. J Microbiol Immunol Infect. 2007;40:513–7.

    PubMed  CAS  Google Scholar 

  7. Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L. Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol. 2007;22:1002–6.

    Article  PubMed  Google Scholar 

  8. Sheu JN, Chen MC, Chen SM, Chen SL, Chiou SY, Lue KH. Relationship between serum and urine interleukin-6 elevations and renal scarring in children with acute pyelonephritis. Scand J Urol Nephrol. 2009;43:133–7.

    Article  PubMed  CAS  Google Scholar 

  9. Rodríguez LM, Marugán JM, Suárez MA, Torres MC. Citoquinas en la patología nefrourológica pediátrica. Arch Latin Nefr Ped. 2003;3:73–81.

    Google Scholar 

  10. Gürgöze MK, Akarsu S, Yilmaz E, Gödekmerdan A, Akça Z, Ciftçi I, et al. Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis. Pediatr Nephrol. 2005;20:1445–8.

    Article  PubMed  Google Scholar 

  11. Robles B, Rodríguez LM, Suárez MA, Marugán JM, Fernández M, de Fuentes MC. Comparación de la utilidad de la fiebre y de algunos parámetros analíticos para el diagnóstico de pielonefritis aguda en niños. Rev Esp Pediatr. 2005;61:358–63.

    Google Scholar 

  12. Otto G, Braconier J, Andreasson A, Svanborg C. Interleukin-6 and disease severity in patients with bacteremic and nonbacteremic febrile urinary tract infection. J Infect Dis. 1999;179:172–9.

    Article  PubMed  CAS  Google Scholar 

  13. Rodríguez LM, Robles B, Marugán JM, Suárez A, Santos F. Urinary interleukin-6 is useful in distinguishing between upper and lower urinary tract infections. Pediatr Nephrol. 2008;23:429–33.

    Article  PubMed  Google Scholar 

  14. Roilides E, Papachristou F, Gioulekas E, Tsaparidou S, Karatzas N, Sotiriou J, et al. Increased urine interleukin-6 concentrations correlate with pyelonephritic changes on 99mTc-dimercaptosuccinic acid scans in neonates with urinary tract infections. J Infect Dis. 1999;180:904–7.

    Google Scholar 

  15. Patel K, Charron M, Hoberman A, Brown ML, Rogers KD. Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol. 1993;23:506–9.

    Article  PubMed  CAS  Google Scholar 

  16. Roushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: Evolving concepts and future directions. Pediatr Nephrol. 1997;11:108–20.

    Google Scholar 

  17. Yang H, Carlin D. ROC surface: A generalization of ROC curve analysis. J Biopharm Stat. 2000;10:183–96.

    Google Scholar 

  18. Jacobson SH, Eklöf O, Lins LE, Wikstad I, Winberg J. Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood—a 27-year follow-up. Pediatr Nephrol. 1992;6:19–24.

    Google Scholar 

  19. Jakobsson B, Berg U, Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child. 1994;70:111–5.

    Article  PubMed  CAS  Google Scholar 

  20. Stokland E, Hellström M, Jacobsson B, Jodal U, Sixt R. Renal damage one year after first urinary tract infection: Role of dimercaptosuccinic acid scintigraphy. J Pediatr. 1996;129:815–20.

    Google Scholar 

  21. Kishimoto T. Interleukin-6 and its receptor; From cloning to clinic. Int Arch Allergy Immunol. 1992;99:172–7.

    Google Scholar 

  22. Sheu JN, Chen MC, Lue KH, Cheng SL, Lee IC, Chen SM, et al. Serum and urine levels of interleukin-6 and interleukin-8 in children with acute pyelonephritis. Cytokine. 2006;36:276–82.

    Article  PubMed  CAS  Google Scholar 

  23. Prat C, Domínguez J, Rodrigo C, Giménez M, Azuara M, Jiménez O, et al. Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection. Pediatr Infect Dis J. 2003;22:438–42.

    PubMed  Google Scholar 

  24. Bressan S, Andreola B, Zucchetta P, Montini G, Burei M, Perilongo G, et al. Procalcitonin as a predictor of renal scarring in infants and young children. Pediatr Nephrol. 2009;24:1199–204.

    Article  PubMed  Google Scholar 

  25. Tullus K, Fituri O, Linné T, Escobar-Billing R, Wikstad I, Karlsson A, et al. Urine interleukin-6 and interleukin-8 in children with acute pyelonephritis, in relation to DMSA scintigraphy in the acute phase and at 1-year follow-up. Pediatr Radiol. 1994;24:513–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of Interest

None.

Role of Funding Source

This study was financed with the grant number nº 97/1125 from “Fondo de Investigaciones Sanitarias”. Gobierno de España.

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Complejo Asistencial Universitario (CAULE), León, Spain

    Luis Miguel Rodríguez

  2. National Health System, Gijón, Asturias, Spain

    Belén Robles

  3. Department of Pediatrics, Hospital Clínico-Universitario, Valladolid, Spain

    José Manuel Marugán

  4. Department of Pediatrics, Gerencia de Atención Primaria, León, Spain

    Ángeles Suárez

  5. Department of Immunology, Complejo Asistencial Universitario (CAULE), León, Spain

    José María García Ruiz de Morales

  6. Servicio de Pediatría, Hospital de León, Altos de Nava s/n., 24080, León, Spain

    Luis Miguel Rodríguez

Authors
  1. Luis Miguel Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Belén Robles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. José Manuel Marugán
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ángeles Suárez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José María García Ruiz de Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Miguel Rodríguez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rodríguez, L.M., Robles, B., Marugán, J.M. et al. Do Serum C-reactive Protein and Interleukin-6 Predict Kidney Scarring After Urinary Tract Infection?. Indian J Pediatr 80, 1002–1006 (2013). https://doi.org/10.1007/s12098-013-1045-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-013-1045-4

Keywords

Search

Navigation