{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:19:08Z","timestamp":1790036348499,"version":"4.0.1"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,8,1]]},"abstract":"<jats:p>Objective. Febrile urinary tract infection (UTI) is a common problem among children. The diagnosis and management of acute pyelonephritis is a challenge, particularly during infancy. The distinction between acute pyelonephritis and UTI without renal involvement is very important, because renal infection may cause parenchymal scarring and thus requires more aggressive investigation and follow-up monitoring. However, this distinction is not easy among children, because common clinical findings and laboratory parameters are nonspecific, especially among young children. In an attempt to differentiate acute pyelonephritis from febrile UTI without renal lesions in a group of 100 children, we measured serum levels of procalcitonin (PCT), a new marker of infection. The objective of the study was to determine the accuracy of PCT measurements, compared with C-reactive protein (CRP) measurements, in diagnosing acute renal involvement during febrile UTI and in predicting subsequent scars, as assessed with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.<\/jats:p>\n               <jats:p>Design. Serum CRP levels, erythrocyte sedimentation rates, leukocyte counts, and PCT levels were measured for 100 children, 1 month to 13 years of age, admitted for suspected febrile UTI (first episode). Renal parenchymal involvement was evaluated with DMSA scintigraphy within 5 days after admission. The DMSA study was repeated 6 months later if the initial results were abnormal.<\/jats:p>\n               <jats:p>Results. The mean PCT level was significantly higher in acute pyelonephritis than in UTI without renal lesions (4.48 \u00b1 5.84 ng\/mL vs 0.44 \u00b1 0.30 ng\/mL). In these 2 groups, the mean CRP levels were 106 \u00b1 68.8 mg\/L and 36.4 \u00b1 26 mg\/L, mean erythrocyte sedimentation rates were 79.1 \u00b1 33 mm\/hour and 58.5 \u00b1 33 mm\/hour, and leukocyte counts were 18 492 \u00b1 6839 cells\/mm3 and 16 741 \u00b1 5302 cells\/mm3, respectively. For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT measurements were 83.3% and 93.6%, respectively; CRP measurements had a sensitivity of 94.4% but a specificity of only 31.9%. Positive and negative predictive values for prediction of renal involvement with PCT measurements were 93.7% and 83% and those with CRP measurements were 61.4% and 83.3%, respectively. When inflammatory markers were correlated with the severity of the renal lesions, as assessed with DMSA scintigraphy, a highly significant correlation with both PCT and CRP levels was found. However, when the 2 parameters were correlated with renal scarring in follow-up scans, a significant positive association was found only for PCT levels.<\/jats:p>\n               <jats:p>Conclusions. Serum PCT levels may be a sensitive and specific measure for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement. Therefore, this measurement could be useful for the treatment of children with febrile UTIs, allowing prediction of patients at risk of permanent parenchymal renal lesions.<\/jats:p>","DOI":"10.1542\/peds.114.2.e249","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e249-e254","source":"Crossref","is-referenced-by-count":119,"title":["Procalcitonin: A Marker of Severity of Acute Pyelonephritis Among Children"],"prefix":"10.1542","volume":"114","author":[{"given":"Paolo","family":"Pecile","sequence":"first","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Miorin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Romanello","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmondo","family":"Falleti","sequence":"additional","affiliation":[{"name":"Department of Pathology and Medicine, Experimental and Clinical"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Valent","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and Epidemiology, School of Medicine, University of Udine, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giacomuzzi","sequence":"additional","affiliation":[{"name":"Institute of Nuclear Medicine, General Hospital, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Tenore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,8,1]]},"reference":[{"key":"2021121006455083900_R1","doi-asserted-by":"crossref","unstructured":"Hoberman A, Chao H-P, Keller DM, Hickey R, Davis HW, Ellis DE. 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