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      Diagnostic accuracy of urinary biomarkers in infants younger than 3 months with urinary tract infection

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          Abstract

          Purpose

          The aim of this study was to evaluate the diagnostic accuracy of urinary biomarkers, such as neutrophil gelatinase-associated lipocalin (uNGAL) and β-2 microglobulin (uB2MG), in early detection of urinary tract infection (UTI) in infants aged <3 months with fever.

          Methods

          A total of 422 infants aged <3 months (male:female=267:155; mean age, 56.4 days), who were admitted for fever, were retrospectively included in this study. We compared uNGAL and uB2MG between the UTI and non-UTI groups at the time of admission. The sensitivity, specificity, accuracy, and area under the curve (AUC) of uNGAL and uB2MG for use in diagnosing UTI were assessed.

          Results

          Among 422 patients, 102 (24.2%) were diagnosed with UTI. Levels of uNGAL were higher in the UTI group than in the non-UTI group (366.6 ng/mL vs. 26.9 ng/mL, P<0.001). Levels of uB2MG were not different between the 2 groups. Multivariate analysis revealed that uNGAL was an independent predictive factor for UTI ( P=0.033). The sensitivity, specificity, and accuracy were 90.2%, 92.5%, and 91.9% for uNGAL, and 48.0%, 43.8%, and 44.8% for uB2MG, respectively. AUC of uNGAL was 0.942 and that of uB2MG was 0.407.

          Conclusion

          Accuracy of uNGAL in the diagnosis of UTI is high in febrile infants aged <3 months. uNGAL can help in the early diagnosis and treatment of UTI in infants.

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          Prevalence of urinary tract infection in childhood: a meta-analysis.

          Max H Farrell, James E. Bost, Nader Shaikh … (2008)
          Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. We conducted a meta-analysis to determine the pooled prevalence of urinary tract infection (UTI) in children by age, gender, race, and circumcision status. MEDLINE and EMBASE databases were searched for articles about pediatric urinary tract infection. Search terms included urinary tract infection, cystitis, pyelonephritis, prevalence and incidence. We included articles in our review if they contained data on the prevalence of UTI in children 0-19 years of age presenting with symptoms of UTI. Of the 51 articles with data on UTI prevalence, 18 met all inclusion criteria. Two evaluators independently reviewed, rated, and abstracted data from each article. Among infants presenting with fever, the overall prevalence (and 95% confidence interval) of UTI was 7.0% (CI: 5.5-8.4). The pooled prevalence rates of febrile UTIs in females aged 0-3 months, 3-6 months, 6-12 months, and >12 months was 7.5%, 5.7%, 8.3%, and 2.1% respectively. Among febrile male infants less than 3 months of age, 2.4% (CI: 1.4-3.5) of circumcised males and 20.1% (CI: 16.8-23.4) of uncircumcised males had a UTI. For the 4 studies that reported UTI prevalence by race, UTI rates were higher among white infants 8.0% (CI: 5.1-11.0) than among black infants 4.7% (CI: 2.1-7.3). Among older children (<19 years) with urinary symptoms, the pooled prevalence of UTI (both febrile and afebrile) was 7.8% (CI: 6.6-8.9). Prevalence rates of UTI varied by age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of UTI. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.
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            Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption.

            Claudio Ronco, Kianoush B Kashani, Wisit Cheungpasitporn (2017)
            Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.
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              Neutrophil gelatinase-associated lipocalin: a promising biomarker for human acute kidney injury.

              Prasad Devarajan (2010)
              Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which depends on serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers has crippled our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The discovery, translation and validation of neutrophil gelatinase-associated lipocalin, arguably the most promising novel AKI biomarker, are reviewed in this article. Neutrophil gelatinase-associated lipocalin is emerging as an excellent standalone troponin-like biomarker in the plasma and urine for the prediction of AKI, monitoring clinical trials in AKI and for the prognosis of AKI in several common clinical scenarios.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Pediatr
                Journal ID (iso-abbrev): Korean J Pediatr
                Journal ID (publisher-id): KJP
                Title: Korean Journal of Pediatrics
                Publisher: The Korean Pediatric Society
                ISSN (Print): 1738-1061
                ISSN (Electronic): 2092-7258
                Publication date (Print): January 2018
                Publication date (Electronic): 22 January 2018
                Volume: 61
                Issue: 1
                Pages: 24-29
                Affiliations
                [1 ]Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.
                [2 ]Department of Urology, Keimyung University School of Medicine, Daegu, Korea.
                [3 ]Department of Nuclear Medicine, Keimyung University School of Medicine, Daegu, Korea.
                Author notes
                Corresponding author: Ji Yong Ha, MD. Department of Urology, Keimyung University School of Medicine, 56 Dalseong-ro Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-7647, Fax: +82-53-250-7643, uroha@ 123456dsmc.or.kr

                *These authors contributed equally to this study and should be considered co-first authors.

                Article
                DOI: 10.3345/kjp.2018.61.1.24
                PMC ID: 5807987
                PubMed ID: 29441109
                SO-VID: 00bee44c-1d19-4a7a-97a9-7a6ce76ad961
                Copyright © Copyright © 2018 by The Korean Pediatric Society
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 31 July 2017
                Date revision received : 25 September 2017
                Date accepted : 26 September 2017
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Pediatrics
                Keywords: urinary tract infection,biomarkers,neutrophil gelatinase-associated lipocalin
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: urinary tract infection, biomarkers, neutrophil gelatinase-associated lipocalin

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