Host and Bacterial Markers that Differ in Children with Cystitis and Pyelonephritis.

Abstract

OBJECTIVE:

To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis.

STUDY DESIGN:

We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes.

RESULTS:

Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis.

CONCLUSIONS:

Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.

• Authors: Nader Shaikh, Judith M Martin, Alejandro Hoberman, Megan Skae, Linette Milkovich, Andrew Nowalk, Christi McElheny, Robert W Hickey, Diana Kearney, Massoud Majd, Eglal Shalaby-Rana, George Tseng, John F Alcorn, Jay Kolls, Marcia Kurs-Lasky, Zhiguang Huo, William Horne, Greg Lockhart, Hans Pohl, Timothy R Shope
• Journal: The Journal of pediatrics (J Pediatr) Vol. 209 Pg. 146-153.e1 (06 2019) ISSN: 1097-6833 [Electronic] United States
• PMID: 30905425 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers

Topics

• Acute Disease
• Bacterial Infections (blood, urine)
• Biomarkers (analysis)
• Child, Preschool
• Cystitis (blood, diagnosis, microbiology, urine)
• Diagnosis, Differential
• Female
• Humans
• Infant
• Male
• Pilot Projects
• Prospective Studies
• Pyelonephritis (blood, chemically induced, microbiology, urine)
• Urinary Tract Infections (blood, urine)