Prediction of renal cortical defect and scar using neutrophil-to-lymphocyte ratio in children with febrile urinary tract infection

Summary

Aim: This study is aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for cortical defect on initial and follow-up Tc-99m dimercaptosuccinic acid (DMSA) scan in children with the first febrile urinary tract infection (UTI). Methods: We retrospectively enrolled 179 children with the first febrile UTI who underwent DMSA scan and laboratory tests. In patients with abnormal DMSA scan findings, follow-up DMSA scan was performed at least 6 months after the initial scan. All DMSA scans were classified as negative and positive cortical defects. Multiple logistic regression analyses were performed to identify the risk factors for cortical defect on initial and follow-up DMSA scan. Results: Cortical defects on initial DMSA scan were noted in 133 patients. Vesicoureteral reflux (VUR), white blood cell count, absolute neutrophil count, NLR, and serum C-reactive protein level were independent predictive factors for positive cortical defect on initial DMSA scan (p < 0.050). On follow-up DMSA scan, 24 of the 133 patients showed persistent cortical defects, and only VUR was significantly associated with persistent cortical defect (p = 0.002). In 84 patients who showed cortical defect on initial scan and absence of VUR, only NLR was significantly associated with persistent cortical defect on follow-up scan (p = 0.025). Conclusion: NLR was significantly associated with persistent cortical defect on follow-up DMSA scan in patients without VUR, as well as positive cortical defect on initial scan.

Zusammenfassung

Ziel: In dieser Studie sollte der prognostische Wert des Neutrophilen-Lymphozyten-Verhält- nisses (NLV) für kortikale Defekte in Erst- und Kontrollaufnahmen mittels Tc-99m-Dimer- captobernsteinsäure (DMSA)-Scan bei Kindern mit einem ersten febrilen Harnwegsinfekt (HWI) untersucht werden. Methoden: Wir rekrutierten retrospektiv 179 Kinder, die bei ihrem ersten febrilen HWI einem DMSA- Scan und Labortests unterzogen worden waren. Bei Patienten mit auffälligen Befunden im DMSA-Scan erfolgte mindestens 6 Monate nach der initialen Aufnahme ein Kontroll- Scan. Alle DMSA-Aufnahmen wurden als negativ bzw. positiv für kortikale Defekte klassifiziert. Mittels multiplen logistischen Regressionsanalysen wurden auf den Erst- und den Kontrollaufnahmen Risikofaktoren für kortikale Defekte identifiziert. Ergebnisse: Kortikale Defekte wurden auf den initialen DMSA-Scans bei 133 Patienten gefunden. Ve- sikoureteraler Reflux (VUR), Leukozytenzahl, absolute Neutrophilenzahl, NLV und der CRP (C-reaktives Protein)-Spiegel waren unabhängige prognostische Faktoren für kortikale Defekte auf den initialen DMSA-Scans (p < 0,050). Auf den Kontrollaufnahmen wiesen 24 der 133 Patienten persistierende kortikale Defekte auf, wobei ein signifikanter Zusammenhang mit persistierenden kortikalen Defekten nur für VUR bestand (p = 0,002). Bei 84 Patienten, die in der Erstaufnahme kortikale Defekte, aber keinen VUR aufwiesen, war nur das NLV signifikant mit persistierenden kortikalen Defekten im Kontroll-Scan assoziiert (p = 0,025). Schlussfolgerung: Bei Patienten ohne VUR war das NLV signifikant mit in den Kontrollaufnahmen persistierenden kortikalen Defekten assoziiert, ebenso wie ein für kortikale Defekte positiver initialer DMSA-Scan.

Keywords

urinary tract infection - Tc-99m DMSA scan - neutrophil-to-lymphocyte ratio - renal scar

Schlüsselwörter

Harnwegsinfektion - Tc-99m-DMSA-Scan - Neutrophilezu-Lymphozyten-Ratio - renale Narbe

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